Skip to main content

Full text of "Harvard medical alumni bulletin"

See other formats



Paul Farmer urges doctors 
to pursue truth, justice, 
and the international way 


John Coll. 

at HMS, performed this early 
operation at Massachusetts Gen- 
eral Hospital. At the time, the 
hospital was using a conical 
sponge soaked in ether instead 
of the glass ether inhaler devised 
by William T. G. Morton, the 
dentist who had made the first 
public demonstration of surgical 
anesthesia the previous year. 





Action Heroes 12 


Soul Survivor 18 

i> V \\ A R R E N K I N G H O R N 

The Snooze Button 20 



Letters 3 

Pulse 5 

Match Day 2003 

President's Report 8 

hy MiuhcU I Rabkm 

Bookshelf 9 

Benchmarks 10 

Unlocking the brain's secrets to 
shyness and investigating the neural 
scaffolding for \ision 

Alumnus Profile 54 

As a Zen Buddhist monk, former 
psychiatrist )im Gordon seeks to 
empty his mind. Jjv Beverly Ballaw 

Class Notes 56 

Obituaries 60 

Endnotes 64 

Health and fitness lessons learned 
in the shadow of sugarcane fields. 
by Sara andjeremv GoldhahcrFiebcrt 


Truth or Scare 24 


Preparing for Battle 26 


The Once and Future Scourge 32 


Lessons from Vaccinia 34 



Outside the Box 38 

bv J O S E P H B . MARTIN 


Reports from the Classes 

Cover photograph 
by Michael O'Neill 

Harvarrl Medimi 


In This Issue 


■ri ^H reminded me that a little terror is an attracti\'e thing. They promised 
the ultimate experience in controlled fear: Freddy vs. Jason in a 
theater near me. I don't know how uni\'ersal is the wish for a httle 
terror, but I can recall when m)' daughter at an early age would ask for a story 
to "scare me, but not too much." For the past year and a half the federal govern- 
ment, with its color coded system of warnings hovering in the yellow to -orange 
range, has in its way gratified this need to be scared in measured quantities. 

Indeed, the fantasy of terror (as opposed to the experience itseK) has its 
rewards. For starters there's the sheer excitement ot it, the stimulation that 
comes as we imagine worlds colliding, bodies invaded, apocalypse at the 
corner store. Next we are flooded by a reassuring sense of our own goodness. 
Whatever our guilty reality, as victims of terror we are washed with innocence. 
Then, armed with automatic purity, in fantasy we can unleash our owti violent, 
hateful impulses either by secretly identifying with the terrorist or by retaliat- 
ing in the most satisfying possible way. Finally, we are brought within a \irtual 
circle of wagons, acquiring a sense of beleaguered community that shares and 
ratifies our image of righteousness. 

Thus, terrorism creates two problems for us. One is the ghastly reality The 
other is the mentality of anticipation, attended by heightened excitement, a 
sense of being on the right side of moral clarity, an urge to impulsive action if 
not violence, and a false sense of unity. .-Vll of these states of mind can lead to 
some very problematic decision making. 

The speakers at .\lumni Day 2003 talked about the hypothetical scenario that 
smallpox could become a terrorist weapon. These experts examined the poten-^ 
tial effect of pohcy decisions directed to a threat not known to exist for certain, 
and they clarified the issues that shrank a plan to vaccinate everybody, first to 
a program that would target half a rrullion health care workers, and then to a 
plan that focused on relatively few, yet critical early responders. 

The speakers, whose talks we must pubUsh in abridged form because of space 
limitations, also highlighted an important shift in the role of pubUc health in an 
age of anticipated terror and small government. Pubhc health departments are 
being drawTi into a key role in the system of national security, often at the cost 
of functions that support or advance the broader health of their communities. 

Come back next year. Sequels are to be expected from the two terror indus- 
tries: the real and the fantastic. 

U]AhoiM\ (aa ^(y^yxJ^ 


William Ira Bennett "68 


Paula Brewer Byron 


Beverly Ballaro, PhD 


Susan Cassidy 


Elissa Ely 


Judy Ann Bigby '78 
Rafael Campo '92 

Elissa Ely '88 

Atu! Ga\\ande "94 

Robert M. Goldwyn '56 

Petri Klass '86 

N'ictoria McEvoy '75 

James J. O'Connell '82 

Nancy E. Oriol '79 

Eleanor Shore '55 


Laura McFadden 


Mitchell T. Rabkin '55, president 

Eve J. Higginbotham '79, president-elect 1 

Joseph K. Hurd, Jr '64, president elect 2 

Paula A. Johnson '85. \ice president 

PhyUis I. Gardner '76, secretary 

Cecil H. Coggins '58, treasurer 


Nancy C. Andrews '87 

Rafael Campo '92 
Donnella S. Green '99 
BarbaraJ. McNeil '66 
Laurence J. Ronan'87 
Mark L. Rosenberg '71 

Kenneth I. Shine '61 

Francis C. Wood, Jr. '54 

Kathryn A. Zufall- Larson '75 


Daniel D. Federman '53 


Nora N. Nercessian, PhD 


Joseph K. Hurd '64 

The Hanard Medical Alumni Bulletin is 

published quarterly at 25 Shattuck Street. 

Boston. \!.-\ 02115 '■ by the Harvard 

Medical .-Mumni .Association. 

Plione; (617) 384 8900 • Fa.\: (617) 384-8901 


Third class postage paid at Boston. 

Massachusetts. Postmaster, send form 3579 

to 25 shattuck Street. Boston, MA 02115 

ISSN 0191-7757 • Printed in the U.S.A. 







I enjoyed reading the Winter 2003 edition of the Bulletin. 
'The Reluctant Physician," the recounting of the immi 
gration of a Boston blueblood. Doc Samuel Bartlett, to 
Manyberries, Alberta, struck a special chord. 

My grandparents migrated from Pennsylvania to 
Duchess, Alberta — 60 miles northwest of Manyberries — 
during World War I. They, too, sought the opportunity 
provided by the Canadian Pacific Railway to homestead 
in fertile prairie soil. By the time I was born in 1938, my 
parents had been contending with the Depression for 
years. My father was a dairy farmer, and we delivered 
milk to the \'illagers early in the morning, several times 
a week. To sur\'ive the harsh winters, we captured mink, 
ermine, and muskrat, and we obtained bounties on 
coyotes to pro\'ide additional needed income. 

My aspiration to become a missionary doctor was 
never realized, but 1 do feel honored to have balanced 
the score — Dr. Bartlett to Alberta, Dr. Martin to Boston. 


Sound Effects 

I read with interest the Winter 2003 
issue of the Bulletin, v\'hich focused on the 
touching of patients. On page 15, the 
Bulletin reproduces a mural by Theobald 

Chartran at the Sorbonne. Rene Laennec 
is shown performing direct auscultation 
of a patient at the Hopital Necker while 
holding his newly im-ented monaural 
stethoscope in his left hand. 

The caption reads, "Tradition has it...." 
There is more to tradition here. Consid- 
er Laennec's v\'ords: "In 1816, I was con- 
sulted by a young woman... [Direct aus- 
cultation] being rendered inadmissible 
by the age and sex of the patient, I hap- 
pened to recollect a simple and well- 
known fact of acoustics.. .the augmenta- 
tion of sound when conveyed through 
certain solid bodies." 

Laennec continued by describing his 
initial use of a rolled "quire of paper" and 
the subsequent experiments he conduct- 
ed to devise the best instrument, of 
which he pro\'ided a detailed drawing. 
He made a number of these instruments 
himself, and they were rapidly accepted 
as superior to direct auscultation. 


Sensible Clues 

I enjoyed your recent special report on 
the value of touch in clinical medicine, 
something rheumatologists know quite 
well. We often eschew instruments 
altogether in favor of touch, sight, and 
hearing when seeing patients. Would 
that the agencies reimbursing us regard 
an examination that relies on the senses 
as equivalent in skill and value to one 
that uses instruments and technology. 


Vanishing Point 

I very much enjoyed the Winter 2003 
issue of the Bulletin. It contains a num- 
ber of articles that address aspects of 
the ideal physician/patient relationship 
that have almost disappeared in our 
current tragic medical care system. 1 
only wish that there were some effec- 
tive approach to the situation whereby 
we could restore viable access to so 
many aspects of the practice of medi- 
cine that so-called "progress" has ren- 
dered almost moribund. 






Thrill of the Chaste 

Kudos on the excellent article on Joe and 
Arthur Sparr and their unique drugstore 
in the Winter 2003 issue. I have remained 
ever grateful to Joe for his loan, which 
permitted me to be properly outfitted for 
the beginning of our first course in phys- 
ical diagnosis. The deal was sealed \\ith a 
handshake — no lOU needed. 

I especially enjoyed reading about 
Holly Smith's heroic weekly purchases 
of a full gross of condoms for research 
purposes. While this was a titillating 
vignette, I wonder whether most of the 
graduates of the past 30 to 40 years real- 
ize that the transactions between Joe 
and Holly were strictly illegal under 
then existent state law. At that time, a 


The 75th anniversary is.sue 
of the Harvard Medical 
Alumni Bulletin was re- 
cently honored with a gold 
medal from CASE, the 
Council for Advancement 
and Support of Education, 
in the periodical special 
issues category. 

statute prohibited the sale, purchase, or 
use (!) of contraceptives in Massachusetts, 
although this law was often honored in 
the breach. Indeed, it was even illegal for 
the Department of Obstetrics to lecture 
on the use of contraceprion (or abortion). 

Partly because of this bizarre law and 
partly because of the armouncement of 
the development of an oral contraceptive 
drug by HMS professor John Rock, 
Celso-Ramon Garcia, and Gregory Pin- 
cus, I decided to give my Boylston Society- 
talk in 1958 on "Contraceptives Since 
.Antiquity." My intention was to con- 
clude with scientific and clinical infor- 
mation on "the PiU." Imagine my surprise 
and dismay when I was permitted nei- 
ther to obtain nor read the references 
that I requisitioned from the HMS 
hbrary. Such salacious material, while 
available, was strictly off-limits for the 
hkes of fourth- year students. The books 
were kept in a locked cabinet. How I got 
access to those books is another story. 

Most of us, at that time, assumed that 
the Comstock-like ban on contracep- 
tives in Massachusetts was the result of 
the effort and influence of the Catholic 
Church, but it actually originated as an 
act of neo-Puritanism. In the course of 
researching my Boylston paper, I learned 
that the laws had been enacted years 
earlier as a result of the lobbying of the 
legislature by the faculty of Wellesley 
College. It was stated that they were 
concerned that the availability of con- 
traception would threaten the morals 
and wtue of their girls. 

My, how times have changed. 



Oral Erudition 

I'm wTiting to supplement Dr. Marion 
Mason's letter in the Spring 2003 issue of 
the Bulletin about a pre\ious wall clock 
owner who had been an honorary mem- 
ber of the medical alumni association. The 
name of that indi\idual was misspelled, 
understandably so because the missing 
letter was a silent "h." He was Kurt H. 
Thoma, DMD, professor of oral surgery 

and Brackett Professor of Oral Patholog)- 
at the Harvard Dental School and chief 
of the Dental Service at Massachusetts 
General Hospital. 

Dr. Thomas tome was Oral Pathology. 
The title page of my 1944 second edition 
of it notes that it contains 1,388 iQustra- 
tions; it also weighs seven pounds and is 
almost three inches thick. Dr. Thoma's 
other books include a more modestly 
sized Oral and Danal Diagnosis, whose third 
edition was pubUshed in 1949. He became 
emeritus when the Dental School was 
closed for several years to be resurrected 
as the present School of Dental Medicine. 


In a Class of Their Own 

Ha\ing just read the Spring 2003 issue 
of the Bulletin, which I greatly enjoyed 
and in which I learned a great deal about 
some of my friends, I felt inspired to let 
you know about the Class of 1939. 

I have kept in close touch with this 
class, of which there are now 28 sur- 
\ivors of the original group of 131. For the 
past five years, we have had an aimual 
reunion; this summer nine members of 
our class attended. We had an enjoyable 
time at the Friday morning alumni meet- 
ing, which was very stimulating, and we 
had a wonderful dinner that evening at 
the home of classmate .Arthur Pier. 

I take great pleasure in talking on the 
telephone to e\'ery sur\i\ing member of 
our class se\eral times a year. We are all 
ver)' loyal to HMS and, in fact, consider- 
ing the limited income that most of us in 
our late 80s ha\e, we have been prett)' 
generous, with a better than 50 percent 
rate of participation in alumni donations. 


The Bulletin welcomes letters to the editor 
Please send letters by mail (Harvard Medical 
.Alumni Bulletia 25 Shattuck Street, Boston, 
Massachusetts 02115); fax (6J 7-384-890J); or 
email (bulletm&hms. hanardxdu). Letters may 
he edited for length or clarity. 







HMS tourch \'cars gathered outside the registrar's office arLxiously awaiting the envelope 
that would tell them where they would be spending their residencies. Of the 160 fourth- 
years who chose a clinical program, 88 (55 percent) will enter an internship at HMS. Fifty- 
sLx percent of the graduates will remain in Massachusetts while 17 percent will go to Cali- 
fornia and 11 percent to New York City. The most popular specialties were internal medicine 
(26 percent), pediatrics (11 percent), radiology (10 percent), and dermatology (8 percent). 
The specialty that gained the most HMS graduates o\'er last year was dermatology; family 
practice, general surgery, and obstetrics/gynecology all saw a decline in popularity. 


Ross Blank 

Massachusetts General Hospital 
Anis Dizdarevic 

B'lgriQ'- ore '.\ -men's Hospital 

Sara Goldhaber-Fiebert 

Massachusetts General Hospital 
Eric Matten 

Massachusetts General Hospital 
Rebecca Reichert 

AAcssachusetts General Hospital 


Otter Aspen 

Boston University Medical 

Marissa Heller 

NYU School of Medicine 
Leonid Izikson 

University Heolth Center, 

Jennifer Lee 

Henry Ford Health Sciences 
Center, Detroit 

Wilson Liao 

University of California- 
San Francisco 

Jennifer Lin 

Massachusetts General Hospital 
Janet Maldonado 

University of California- 
San Francisco 
Emanual Maverakis 

University of California-Davis 
Medical Center, Sacramento 

Daniel McGinley-Smith 

Dortnnouth-Hitchcock Medical 


Megan Moore 

NYU School of Medicine 

Shala Rahbar 

Massachusetts General 

Ki-Young Suh 

McGow Medical Center, 
Northwestern University 

Jenny Sun 

McGow Medical Center, 
Northwestern University 

Kenneth Tsai 

Massachusetts General 


Michael Guirguis 

Lomo Linda University, CA 
Maurice Jeter, Jr. 

George Washington University 
Benjamin Leader 

Rhode Island HosDitol/Brown 


L. Thomas Richards 

Alameda County Medical Center, 
Oakland, CA 

Josef Simon 

Brigham and Women's Hospital 


Anna Flattau 

New York Presbyterian 
Hospital (Columbia) 
Laura Hodo 

University of Utah Affiliated 
Hospitals, Salt Lake City 


Tammy Chang 

University of California- 
San Francisco 

Aimee Crago 

Georgetown Umve^sl^/ Hospitol 

Jessica Erdmonn-Sager 

Beth Israel Medical Center 

Karen Ho 

Brigham and Women's Hospital 

Jeonv^on Kong 

Massachusetts General Hospital 

John LoMottino 

Massachusetts General Hospital 

Christian Ochoa 

University of Southern California 

Timothy Ryan 

Stanford University Programs 

Christine Weeks 

Brigham and Women's Hospital 

Berhane Worku 

NYU School of Medicine 


Sam Ahn 

Yale-New Haven Hospital 

Sean Amos 

Horbor-UCLA Medical Center 

John Ausiello 

Massachusetts General Hospital 

Katharine Black 

Brigham and Women's Hospital 



Luis Castellanos 

University of California-San 
Diego Medical Center 

Amy Chien 

Massachusetts General Hospital 
Yung Chyung 
Massachusetts General Hospital 
Catherine Crosland 
Brigham and Women's Hospital 
Emil deGoma 
Stanford University Programs 
Matthe>v Fei 
University of California- 
San Francisco 
Joshua Galanter 
UCLA Medical Center 
Hayley Gershengorn 
New York Presbyterian 
Hospital (Cornell) 
Benjamin Gevy^urz 
Beth Israel Deaconess 
Medical Center 
Vivian Gonzalez Lefebre 
Brigham and Women's Hospital 

Jennifer Ho 

Brigham end Women's Hospital 

Malia Jackson 

New York Presbyterian 

Hospital (Columbia) 

Jennifer King 

Massachusetts General Hospital 

Kasia Lipska 

Brigham and Women's Hospital 

Evan Lyon 

Brigham and Women's Hospital 

George Mendenhall 

Mt, Auburn Hospital, 
Cambridge, MA 

Felipe Molina 

New York Presbyterian 

Hospital (Cornell) 

Jose Mora 

Brigham and Women's Hospital 

Joshua Moss 

Massachusetts General Hospital 

Lome Murray 

Massachusetts General Hospital 

Chiadi Ndumele 

Brigham and Women's Hospital 

Meagan O'Brien 

New York Presbyterian Hospital 


Scott Peterson 

Brigham and Women's Hospital 

Marvin Ryou 

Brigham and Women's Hospital 

Rahul Sakhuja 

Massachusetts General Hospital 

David Sher 

Beth Israel Deaconess 

Medical Center 

Kerri Smith 

Massachusetts General Hospital 

Sohail Tavazoie 

Brigham and Women's Hospital 

David Walton 

Brigham and Women's Hospital 

Freddie Williams 

Duke University Medical Center 

Robert Yeh 

Massachusetts General Hospital 

Channing Yu 

Massachusetts General Hospital 



Brigham and Women's Hospital 

Laura Frain 

Brigham and Women's Hospital 

Mark Friedberg 

Brigham and Women's Hospital 

Christina Harris 

New York Presbyterian 

Hospital (Cornell) 

John McWilliams 

Brigham and Women's Hospital 

Aimee Shu 

Brigham and Women's Hospital 


Charmaine Smith 

General Hospital 


Alexandre Carter 

Washington University, St. Louis 
Alice Chen 

General Hospital and Brigham 
and Women's Hospital 

Heather Hinds 

University of California- 
San Francisco 


Lance Governale 

Horvard/Brigham and 
Women's Hospital 


Alison Douglass 

Brigham and Women's Hospital 

Melody Hou 

UCLA Medical Center 

Janet McLaren 

Brigham and Women's Hospital 


R. Prince Davis II 

University of Miami/Bascom 

Palmer Eye Institute 

Vatsal Doshi 

University of Southern California 

Holly Hindman 

Johns Hopkins/Wilmer Eye 

Institute, Sinai, Baltimore 

Adrienne Ruth 

Emory University 

Scott Warden 

Massachusetts Eye and Ear Infirmor/ 


Nanlin Chiang 

Massachusetts General Hospital 
Edv\^ard Lahey 

Massachusetts General Hospital 
Marci Levine 

Massachusetts General Hospital 
Brian Shah 

Massachusetts General Hospital 


Michael Chang 

University of Iowa Hospital 
Lawrence Gulotta 

Hospital for Special Surgery, 
New York, NY 

Raymond Hv^ang 


General Hospital 

Eugene Koh 

Rhode Island Hospital/Brown 


Mark Price 


General Hospital 


Ramy Arnaout 

Brigham and Women's Hospital 
Joseph Carlson 

Brigham and Women's Hospital 
Ami Goradia 

Hospital of the University 
of Pennsylvania 

Finny Kuruvilla 

Brigham and Women's Hospital 
David Wu 

Brigham and Women's Hospital 


Kristin Ammon 

University of California- 
San Francisco 

Jeffrey Edv^ards 

Children's Hospital, Boston 
Sansei Fovrler 

St. Christopher's Hospital for 
Children, Philadelphia 

Mary Gordon 

Childrens Hospital, Boston 
Susan Gurgel 

Children's Hospital, 

Virginia Hsu 

Children's Memorial Hospital, 


Leah Kern 

Children's Notional Medical 
Center, Washington, DC 

Alaina Kipps 

Stanford University Programs 
Michelle Lee 

Children's Hospital, Philadelphia 

Raymond Liu 

New York Presbyterian 
Hospital (Columbia) 


Kira Marciniak 

University of Washington 
Affiliated Hospitals, Seattle 

Vi Nguyen 

Massacfiusetts General 

Michael Rosen 

Cfiildren's Hospital, Boston 
Tina Rutar 

Cfiildrens Hospital, Boston 
Takara Stanley 
Massachusetts General 
Lisa S^artz 
Children's Hospital, Boston 
Jonathan Wassermon 
Children's Hospital, Boston 
Emily Willner 
Children's Hospital, Boston 


Ralph Vetters 

Childrens Hospital, Boston 


Clark Schierle 

McGaw Medical 
University Programs 


Michelle Benger-Merrill 

New York Presbyterian 
Hospital (Columbia) 
Lisa Catapano 

George Washington 
University, Washington, DC 

Jim Hammel 

Stanford University Programs 
David Merrill 
New York Presbyterian 
Hospital (Columbia) 
Mireya Nodal-Vicens 
Massachusetts General 

Matthew Rosa 
Duke University Medical 


Warren Kinghorn 

Duke University 
Medical Center 


Matthe>v Allen 

University of Texas/MD Ander- 
son Cancer Center, Houston 

Christine Chung 

Brighom and Women's 


Jason Efstathiou 

Brigham and Women's 

Amy Gillis 

University of California- 
San Francisco 
Virginia Goytia 

Dual Residency/PhD, Universi- 
ty of Texas Health Science 
Center, San Antonio 

Ir^in Lee 

University of Michigan 
Hospitals, Ann Arbor 

Percy Lee 

Stanford University Programs 


Ryan Albritton 

University of California- 
San Francisco 
Andrev^ Bennett 
Beth Israel Deaconess 
Medical Center 
Teran Colen 
University of Washington 
Affiliated Hospitals, Seattle 
Glenn Gaviola 
Brigham and Women's 

John Gleason 

University of Michigan 
Hospitals, Ann Arbor 

AndrevN^ Hines-Peralta 

Beth Israel Deaconess 
Medical Center 
Bobak Kalantari 

UCLA Medical Center 

Mykol Larvie 

Massachusetts General 

Alexander Le 
Yale-New Haven Hospital 
Jeffrey Lin 
Barnes-Jewish Hospital, 
St. Louis 
Frank Minja 
Yale-New Haven Hospital 

Alex Sinelnikov 

Massachusetts General 


Abraha Taddese 

Mt. Sinai Medical Center, 

Andy Tsai 

Brigham and Women's Hospital 
Sudhir Vora 

Thomas Jefferson University, 


Jacob Wouden 

Brigham and Women's Hospital 
Jong Yun 

Massachusetts General 

Alexander Kutikov 

Hospital of the University of 
Pennsylvania, Philadelphia 
Todd Morgan 
U^lversl^y of Washington 
Affiliated Hospitals, Seattle 
Andrea Wolf 
Massachusetts General 


Gregory Chang 

Alternate, US. National 
Fencing Team/2004 
Olympic Trials 
Sristhi Gupta 

Associate, McKinsey & 
Company, Florham Pork, NJ 

Vasant Narasimhan 

Consultant, Rockefeller 
Foundation Health Equity 
Program, New York, NY 
Mary Tharayil 

Master's in Public Health, 
Harvard Scfiool of Public 
April Wang 

Clinical Research, 
Massachusetts General Hospital 


Left Bank 

W'e offer rental of our spaciou.s, 

well appointed 17th century aparttnent 

home. The period deeor includes all 

inodern conveniences. The location is 

the finest in Paris, on the Rue de 

V'arenne, 7th Arrondissement. Maid 

service and our Guide to the Best ofram 

are included for free. 


Cart b h e a n 

We offer rental of our wonderful home 
on the ideal tropical island. Our 
spacious property has a private pool 
and is carefully tended, perfect for 
honeymoons and relaxing vacations. 
Maid service and our Guide to the Best 
of St. Bans are included free of charge. 

(650) 327-2415 


See l;on> ti;e world SM||ers... 
See what ^on can bo to f;e[)). 

Catholic Doctors needed to 

serve at Mission Hospitals 

and Clinics in Africa 

and Latin America. 


Supporting Catholic 

Mission Doctors 

Since 1959 

Mission Doctors Association 

3424 Wilshire Blvd., Los Angeles, CA 

(213) 637-7499 



Nursing the Nursing Profession Back to Health 

at hospitals across the country to look out for our 
graduates arriving as fledgling residents and to 
welcome them. I do so once again; it is an annual 
opportunity for you, as members of the HMS com- 
munity our graduates have now entered, to be helpful to the 
new arrivals. Thank you for your thoughtfulness. 

I recently saw projected numbers of nursing personnel 
for the next couple of decades and concluded that we 
physicians will soon have another headache to add to our 
woes. The anticipated shortage may relate in part to a fail- 
ure of some physicians and administrators to appreciate the 
professionalism of nursing, thus denigrating that crucial 
role in the care of patients. One cannot simply substitute 
technicians and unskilled personnel and expect that the 
work of the graduate nurse will be done. 

That concern led me to question whether Harvard Uni- 
versity might consider establishing a college or program 
in nursing leading to a bachelor's degree or develop one 
that offers college graduates an advanced degree and 
entry into the nursing profession. True, Massachusetts 
General Hospital has its Institute of Health Professions, 
but the numbers do not approach the anticipated needs of 
our several teaching hospitals and other venues, including 
physicians' offices. 

One cannot simply substitute technicians 
and unskilled personnel and expect that the 
work of the graduate nurse will be done. 

read of the literature confirms that dour \"iew; most of what 
is published nowadays seems to deal with failures of exist- 
ing programs or projections of doom. It struck a colleague, 
John Cook, and me that it might be useful to list basic prin- 
ciples to guide positive change in health care financing and 
delivery. In an article published last November, titled "A 
New Approach to Medicare: Implications for Health Care 
Reform and for Medical Education" [Acacicmic Medicine 
2002;77;1069-75], we offered the following: 

• Cost control is not possible without a budget. 

• The budget must provide fair payment for the services 

• Medical care decision making should be done by physi- 
cians and their patients, based on the best scientific 
evidence available being applied to the care of the indi- 
vidual patient. 

• Along with appropriate payment to care providers, there 
should be reasonable economic incentives to achieve 
budget targets, quality- of- care standards, and patient 

• These economic incentives should be comparable across 
the spectrum of payers. 

• For the advancement of medicine in the United States, 
appropriate support for medical and nursing education 

should be provided, and 
because patients of all payers 
benefit, all payers should 

What are your thoughts? 

Given that clinical research and teaching at Harvard 
require the presence of patients, there is wisdom, it seems to 
me, in appreciating the need for trained professional staff — 
and not only physicians — to meet those clinical and academ- 
ic responsibilities. Those who doubt whether the nursing 
profession is worthy to be graced through connection v\ith 
Harvard University might peruse From Novice to Expert (Pren- 
tice Hall, 2001), by Patricia Benner, professor of nursing at the 
University of California, San Francisco, and focus especially 
on her description of the several domains of professional 
nursing. It might be an eye opener to you, as it was to me. 

A noted economist recently opined on the present state 
of health care reform, "Washington is bereft of ideas." My 

Parting words: Warm thanks 
to Nora Nercessian, associ 
ate dean for alumni pro- 
grams and special projects, 
and to Daniel Federman '53, 
senior dean for alumni relations and cUnical teaching, for 
their colleagueship and support of the Alumni Council, and 
to Dean Joseph Martin for his visionary leadership of the 
School and his support of alumni activities. .And a generous 
tip of the hat to William Bennett '68, editor-in-chief, and 
Paula Byron, editor of the Harvard Medical Alumni Bulletin, for 
the quahty of this journal. It reflects the standard of excel- 
lence to which we all strive at HMS. ■ 

Mitchell T. Rabldn '55 is an Institute Scholar at the Carl]. Shapiro 
Institute for Education and Research at HMS and the Beth Israel 
Deaconess Medical Center as well as chief executive officer emeritus 
of Beth Israel Hospital and CareGroup. 




Everything you 
NEVER wanted 
.out kid. CO kno. 

about SEX 


v.ny it hoppers 

01C how best 
to redt :^ 





The Yale Guide to Careers in Medicine 
and the Health Professions 

Pathways to Wcdicinc m the 21st Lcntury. 
edited by Robert M. Donaldson, Jr., 
Kathleen S. Lundgren, and Howard M. 
Spiro '47 (Yak University Press, 2003) 

This guide explores a range of health 
professions — including doctoring and 
nursing, biomedical research and med- 
ical sociology, midwifery and medical 
writing — with essays written by people 
who have taken those career paths. 
More than 70 health professionals can 
didly discuss how and why they made 
their career choices. 

Everything You Never Wanted 
Your Kids to Know About Sex 
(But Were Afraid They'd Ask) 

The Secrets to Sur\'i\'!/ii; Your Child's Sexual 
Development from Birth to the Teens. 
by Justin Richardson '89 and Mark 
A. Schuster '87 (Crown, 2003) 

The authors, one a psychiatrist and the 
other a pediatrician and researcher, 
offer a guide through the many chal 
lenges parents are likely to face in com- 
municating with their children about 
sex. They outline the typical sexual 
maturation process of boys and girls 
and cover the latest research on parent- 
ing and childhood sexuality. The book 
includes anecdotes from parents about 
what worked — and what didn't work — 
with their children. 

Heal the Pain, Comfort the Spirit 

T/ic Hows and Whys of Modern Pain 
Treatment, by Dorene O'Hara '83 
(University o} Pennsylvania Press, 2002) 

What happens to our bodies and minds 
when we encounter pain? O'Hara, an 
anesthesiologist and pain specialist, 
explains the biology of painful injury. She 
also explores how standard medical and 
physical therapies work and considers 
the future of pain treatment, including 
the contributions of alternative medi 
cine practitioners. 


why It Happens and How Best to Reduce 
Your Risks — .4 Doctor's Guide to the Facts, 
by Henry M. Lerner '75 (Perseus 
Publishing, 2003) 

The causes of miscarriage and the best 
methods for recovery are the focus of 
this book. The author discusses the 
diagnostic tests and surgical procedures 
available to help prevent miscarriage 
and offers advice on coping with the 
psychological effects often experienced 
after the loss of a pregnancy. 

Cardiovascular Magnetic Resonance 

by Warren J. Manning '83 and L">udlcy J. 
Pennell (Churchill Livingstone. 2002) 

tal heart disease. Sixty-five experts con- 
tributed to the volume, which reviews 
the basic principles of cardiovascular 
magnetic resonance imaging, discusses 
current techniques, and highlights areas 
oi clinical potential. 

By All Means, Resuscitate 

.4 Memoir, by David L. Chamovitz '48 

This book covers the diagnosis and 
management of ischemic, valvular, myo 
pathic, pericardial, aortic, and congeni- 

The cornerstone of this memoir is the 
author's move to Israel at the peak of 
his medical career. Chamovitz prac 
ticed cardiology and nuclear medicine 
for 28 years and opened one of the first 
cardiac care units in western Pennsyl- 
vania. But in 1984, he and his wife 
moved to Israel, where he developed the 
Department of Nuclear Medicine at a 
600-bed hospital near Tel Aviv and 
began studying Hebrew to communi- 
cate with his new patients. 

When Walking Fails 

Mobility Problems of Adults with Chronic 
Conditions, by Lisa I. lezzoni '84 
(University of California Press, 2003) 

The author explores the lives and chal- 
lenges of American adults with mobility 
problems. She offers insight gleaned 
from interviewing more than a hundred 
people with walking difficulties and 
reflects on her own mobility problems 
due to multiple sclerosis. She also dis- 
cusses strategies for improving mobility 
and dealing with the health care system. 


E N C H M A H K S 


Gaining One's Inhibitions 


for centuries over why some 
individuals seek out new 
people, things, and places 
while others shun them. Researchers 
have suspected that the difference 
between shy and outgoing people lies 
to some extent in their biological make- 
up, in particular their brains. But they 
have been unable to locate where those 
neurological roots lie. Now, a team of 
HMS scientists reports that the amyg- 
dala, an almond-shaped cluster of neu- 
rons buried below the prow of the 
brain, may pro\ide clues to this funda- 
mental human distinction. 

Carl Schwartz and his colleagues 
found that adults who had been iden- 
tified as having shy, inhibited tempera- 
ments when they were two years old 
exhibited greater amygdalar activity 
when shown pictures of unfamiliar 
faces than did adults who had been 
classified as uninhibited or outgoing. 

The findings, which appear in the 
June 20 issue of Science, are of more 
than theoretical interest. Inhibited 
temperament is a risk factor for gener- 
alized social anxiety disorder and, 
indeed, a better understanding of how 
biological structures such as the amyg- 
dala interact with environmental fac- 
tors could lead to a better understand- 
ing of the causes and treatments of this 
destructive psychiatric disease. "There 
is no way to intervene early in the life 
of a child to prevent suffering without 
understanding these developmental 
risk factors," says Schwartz. 

An HMS assistant professor of psy- 
chiatry at Massachusetts General 
Hospital, Schwartz began to explore 
the possibility that the amygdala 
might play a role in temperament near 
ly 15 years ago while working with 
Jerome Kagan, the Daniel and Amy 
Starch Research Professor of Psycholo- 
gy at Harvard University. Kagan and 
his colleagues had shown that inhibit- 
ed children exhibit striking physiolog- 

ical features: their heart rate is faster 
and more variable; their pupils dUate 
more when they are solving problems; 
and they produce more Cortisol than 
their uninhibited counterparts. 

"The question was, what part of the 
brain had to be hyperactive to produce 

those physiological effects?" asks 
Schv\'artz. .Although the amygdala is best 
known for its role in emotion, it also reg- 
ulates autonomic responses. Kagan and 
Schwartz became intrigued by the possi- 
biht)' that the structure might play a role 
in temperament. But it was years later. 



lifter becoming trained in functional 
magnetic resonance techniques, that 
Schwartz would have a chance to 
explore the idea along with Kagan 
and colleagues. 

While their findings appear to 
add another feather to the amygdala's 
hat, they raise questions about its old 
image as a master of emotion. For 
example, this nerve cell cluster is 
often associated with the fear 
response. Yet the unfamiliar faces 
shown to Schwartz's subjects were 
neutral, not threatening. He thinks 
that the amygdala's real function may 
be to detect new and ambiguous 
stimuh and that fearful stimuli might 
fall into that broader category. "A 
wider role for the amygdala," he says, 
"could be that it is in\'olved in the 
detection of novelty and ambiguity." 

He and his colleagues made yet 
another pot stirring discovery, one 
that could have implications for the 
diagnosis and treatment of general- 
ized social anxiety. As it turned out, 
two of the inhibited subjects in the 
study were diagnosed with the dis- 
order. Yet they displayed the same 
pattern of amygdalar acti\ity as the 
inhibited subjects who did not have 
a psychiatric diagnosis. 

"If I had started with people with 
anxiety disorder, we would have 
found a difference in the amygdala," 
Schwartz says. "I might ha\'e gone on 
to say this is a marker for the 
Wrong — this a marker for the risk 
factor of inhibited temperament." 

Schwartz believes the rush to 
discover new drug targets could 
lead some to confuse disease markers 
with risk factors, not just in the case 
of social phobias but in other psychi- 
atric disorders. "If nature is being that 
subtle in this case — well, she is u,sual- 
ly kind of consistent in that w-ay." ■ 

Misia Landau h the senior science writer 
for Focus. 

Wired for Sight 


up some of the mystery sur- 
rounding a key structure in 
the developing brain that 
helps form the visual circuits. Their 
findings, v/hich appear in the July 25 
issue of Science, could provide new 
insight into brain defects. 

During development, nerve cells in 
the eye send messages to the thala- 
mus, which then transmits the mes- 
sages to the visual cortex. This connec- 
tion initially passes through a transient 
and seldom-studied structure called the 
subplate. By removing parts of the 
subplate in cats, the researchers have 
shown that it is a key component in 
strengthening the thalamocortical con- 
nection and in shaping cortical wiring 
patterns important for vision. 

The subplate neurons act like scaf- 
folding for the neural circuits, direct- 
ing and strengthening important path- 
ways before disappearing, says 
senior author Carlo Shatz, chair of 
the HMS Department of Neurobiolo- 
gy. "You make sure all the connec- 
tions in the building are really strong 
so the thing doesn't fall down, and 
then you remove the scaffolding." 
Once the brain is fully developed and 
the subplate neurons start to die, the 
thalamus sends its signals directly to 
the developing visual cortex, bypass- 
ing the dismantling subplate. 

In humans, the scaffolding disap- 
pears by age two, but if is highly 
susceptible to damage even in the 
womb. The subplate neurons mature 
early and thus require lots of oxygen 
for their metabolic processes. Oxygen 
deprivation could harm the subplate 
and lead to such defects as cerebral 
palsy or other disabilities. 

Research on subplate neurons has 
proven difficult in the post because the 
cells are located under the cerebral 
cortex and disappear with maturity. 
This did not deter Patrick Konold, a 
research fellow in neurobiology at 
HMS and lead author of the study, 

and his colleagues, who used toxins 
that targeted specific molecules on the 
subplate neurons to selectively remove 
ports of the structure. 

The investigators examined the 
neural connections that originate in 
the lateral geniculate nucleus (LGN) — 
a thalamic region receiving input from 
the retina — and terminate in a late- 
developing area of the visual cortex 
labeled layer 4. There, highly special- 
ized columns of cells form, which ore 
involved in analyzing visual stimuli. 
Nobel Prize-winning work by David 
Hubel and Torsten Wiesel at HMS 
demonstrated that the thalamic con- 
nections to the nerve cells in the cortex 
help form these columns, which ana- 
lyze such visual features as vertical 
and horizontal orientation. 

By removing the subplotes from 
immature cats, the group has shown 
that not only is the structure involved 
in strengthening the signal from the 
LGN to the layer 4 neurons, but with- 
out it, the distinctive ocular dominance 
and orientation columns do not form. 

"Taking out the subplate arrests cor- 
tical development," soys Kanold, who 
showed that neurons in the visual cor- 
tex with a disrupted subplate could 
not distinguish light bars of different 
orientations — whether the lines were 
vertical, horizontal, or at on angle. 
This was a clear indication that their 
orientation columns hod not formed 
properly. He also showed that the sig- 
nals between the LGN and the layer 4 
neurons were much weaker in brains 
with missing subplate neurons. ■ 

Caia Remerowski is a former intern at 




smiled knowingly when you 
looked at your programs and 
noted the title of my speech, 
"If You Take the Red Pill." If 
my research is sound, most of 
you know that 1 am talking 
about neither a vitamin nor 
the stool softener Colace. It 
was a Harvard librarian, in fact, who showed me data sug- 
gesting that fully 94.2 percent of you have seen The Matrix. 
A word to those unfamiliar with my reference to The 
Matrix: It's an action film starring that great thespian 
Keanu Reeves. The plot is murky but not uninteresting: 

Reeves's character is a cog in the great wheel of industry 
and finance, just another programmer working in front of a 
computer screen in a gray cubicle. Mr. Anderson, as he is 
called, knows something is wrong with the world but 
doesn't know what it is. It's "like a splinter in his mind." 
There's got to be more to life than this, he's certain. He feels 
most alive under an alias, his hacker name, Neo. To make a 
convoluted story short, a certain Morpheus, someone the 
company drones and police term a terrorist, contacts Neo. 
(Morpheus is played in completely over-the-top fashion by 
Laurence Fishburne.) If Neo wants to find out what's bug- 
ging him — all the mediocrity and meaninglessness of life in 
the machine — then Morpheus will be only too happy to 
show him. You have to admit that the plot line is a good 
one. And relevant to the world we inhabit. 

Morpheus gives Neo two options: he can choose to see the 
world as it really is, or he can chicken out. Morpheus out- 
lines Neo's choice with all the subtlety of a mediocre Shake- 
spearean actor who's had a few too many vodka tonics. He 
pulls a pillbox out of his styhri leather coat. He proffers a red 
pill and a blue pill (and no, this is not the blue pill of interest 
to our senior faculty and to Pfizer stockholders). And he says 
something like this: "You take the blue pill, the story ends, 
you wake up in your bed and belie\'e whatever you \\'ant to 
beheve. You take the red pill, you remain in Wonderland and 
I show you how deep the rabbit hole goes." 

Like any good action hero with a splinter 
in his mind, Neo chooses to go for truth, 
which is all that Morpheus has promised. 
And the truth is ugly. It's that Neo, and 
indeed everyone he's ever known, is a slave. 
Never mind, just now, what the mechanism 
of their enslavement is. I don't want to spoil 
the surprise for the seven of you who haven't 
seen the movie. The message is clear: Neo's 
been duped, deluded by job security and 
superficial comforts like cool club music and 
hip garb. It's all fake. 

It's my contention, of course, that a cer- 
tain amount of red-pill popping is just what 
we need in medicine and public health. But 
how many of us want to see how deep the 
rabbit hole goes? 

Do we dare to take the red pill? I pose this 
to you as a serious question from a guy who 
is gagging on the red piU and stiU falling 
down the rabbit hole. As a character in the 
film — a bad guy, of course — says, "Ignorance is bliss." 

But ignorance is not bliss. Ignorance is just that — igno- 
rance — and ignorance and medicine are simply incompati- 
ble. And so our own red pill may well be more bitter than 
any other, because it's easy to argue that, for doctors as for 
scientists, the blue pill is an unacceptable option, even if 
it's what most of us have swallowed. 

Gagging, I just said. Still falling. How so? To be here today, 
I traveled from rural Haiti to Boston \ia Moscow. And 
tomorrow I'm headed to Rwanda via Knoxville, Tennessee; 
it's not a direct flight. Then back to Haiti, and after ten days, 
back to Africa. You've all heard of the Ne\\' York shuttle. 
Well, I've been taking the Harvard-Haiti shuttle for 20 years, 
and I can tell you, it gets old. One starts hoping to come 
across a blue pill in those paltry bags of airplane peanuts, 
which currently constitute 32 percent of my dietary intake. 
What's all this frenetic tra\'el about? It's about the red piU. 
Honest. It's not that taking the truth piU leads you to board 
international fhghts. It's rather that if you take it and you're a 
doctor, you see that there's unnecessary sickness and suffer- 
ing everywhere on this planet. You see, too, that certain epi- 
demics are completely out of control and that each of the 
places I've just mentioned has horrific health emergencies. 
You see that some people are denied access to the most basic 
fruits of science, to the tools de\'eloped over the past few 
decades as medicine itself became "the youngest science." 


Pm an infectious disease doc, so of course I'm going to tafk 
about epidemics. You think SARS is bad, and it is. But allow 
me to put this latest epidemic in perspective. As of today, 
although fewer than a thousand people have died of SARS, 
several Fortune 500 companies are scrambling to put togeth- 
er a global SARS fund; I'm told that more than a hundred mil- 
hon dollars have been pledged. I just read that certain airports 
in Asia ha\'e installed thermal scanners to identify febrile trav 
elers. .AH this in the space of a couple months. All good. 

But every day more than 8,000 people die of AIDS, the 
leading infectious cause of death in the modern world. And 
many more die of tuberculosis and malaria; during the course 
of this year, sLx million people, most of them children and 
young adults, will die of these three diseases alone. SLx mil- 
lion deaths, almost all of them preventable with modern 
medicine, but the red pill reminds us that we have no plan in 
place to serve those most in need. And even the newspapers, 
whose editors and publishers seem to subsist on a steady diet 
of blue pills, report that the Global Fund to Fight AIDS, 

Tuberculosis and Malaria will soon run out of money. The 
plagues of the poor don't seem to interest industry, the press, 
or even basic science. 

And so it is everywhere. Take the red pill and suddenly 
you see that more than 40 milhon Americans have no health 
insurance and as many more are poorly insured. Take the red 
pill and you see that the bottom billion of this planet don't 
have enough food or clean water while in other places, 
including this country, we are called to subsidize agribusi- 
ness and then destroy excess crops or dump them on falter- 
ing peasant economies. Take the red pill and you wonder 
why it is that, in the global era of cormecti\ity, miUions die of 
hunger while others battle obesity. You learn that some com- 
panies short-date perfectly good medications and equip- 
ment in a process known as planned obsolescence while 
tens of milhons will die without ever having benefited from 
the discoveries of Salk or Sabin or even Pasteur. 

This has been going on for some time in the desert of the 
real, and it's getting worse. But here's a glass halt-full for you; 



one-legged man pictured 
here works as a farm 
laborer in Haiti. He walks 
on his hands to the fields, 
where he harvests crops 
for other poor people. 

doctors are granted special license to fight for a better v\'orld. 
Sure, it's Utopian, but it's also feasible. We can carp about 
health insurance in a way that pohticians cannot, because 
we are merely fighting for our patients. 'We can gripe about 
drug prices in a way that others cannot, for the same reason. 
"We can even deliver red-pill speeches like this one \\'ithout 
being considered prlls ourselves. 

Because this is what we're called to do: to fight for the sur- 
\ival and the dignity of our patients, especially the sickest 
and most vulnerable. You don't have to tra\'el far to meet peo- 
ple who receive substandard care. Some of you have worked 
with my own group, Partners in Health, in a neighborhood 
less than a mile from here. But you've already learned, if 
you've taken the red pill, that it's after the patients lea\'e the 
hospital that many of them have trouble — trouble under- 
standing or following doctors' orders. Trouble filling pre- 
scriptions. Trouble getting to clinic appointments. Trouble 
paying rent or utility bills. 

You could address some of these troubles yourselves. 
Say you're an orthopedics resident and on the way from 
the hospital to the gym, you pop by to see the lady who fell 
and fractured her femoral neck. You helped to put in the 
hardware and all went splendidly, as you noted in your 
(very) brief op note. But she lives on the fifth floor of a 
run-down public housing building not a mile from the 
medical mecca in which you train. And the elevator's out. 
If you'd taken the blue pill, you wouldn't even know this 
fact, because she lives in the desert of the real — invisible, 
it would seem, to most doctors. 

Let's bring this back to earth, some of you may be thinking. 
You're worr)ing instead about internship and beyond. The 
hours are too long, and being a doctor can be hard at three in 
the morning. But surely it's not as hard as being a patient. 
How hard is it, really, to be a practitioner of modern biomed- 
icine? On all these planes I take around the world, I see the 
captains of industry looking \'ery industrious. I'm usually 
reading People magazine and they're re\'iewing their spread- 
sheets. Do you think, really, that we work all that much hard- 
er than bankers or stockbrokers? I'm not cominced, frankly. 

Rather, it's what we do that is so radically different. 
Whether internist or pediatrician or pathologist or cardiac 
surgeon, we are working for others. It's not about us, or our 
incomes, or our sense of personal efficacy. It's about what 
happens to our patients. Or, for those of you who are scien- 
tists, it's about the knowledge you create that can help heal 
a wounded world. 

After a few 80-hour work weeks, you may have moments 
when you want to take the blue pill. Don't do it. Wonderful 
things are happening in clinical medicine and the allied sci- 
ences, in large part because of medicine's embrace of sci- 
ence. The yield of this embrace has been nothing short of 
miraculous. From pathology to oncology to infectious 
disease, the revolution continues. 

But for those who take the red pill, we're obhged to see the 
dark side of progress. More and better discoveries, every day, 
but an erosion in our abiht}' to use them ^^•isely and equitably. 
More capacit)' to engineer new therapies but a lack of com- 
mitment to directing our efforts toward the world's great 

This is what we're called to do: to fight for the surviva]| 



killers. In my field, there have been many victories, certainly. 
But there hasn't been a new class of anti tuberculosis drug 
disco\'ercd in decades. There are no effective \'accincs for 
AIDS, tuberculosis, or miliaria — the big three modern plagues. 

Visits to the lifeworlds of the sick help show us that we're 
failures in the equity department. These visits help us under 
stand why excellent in hospital care can come to naught if 
we don't ha\e an equity plan. They help us understand why 
prescriptions go unfilled, why appointments are missed, why 
medications are taken incorrectly or not at aU. These visits 
connect us to people whose lives are very different from our 
ovvTi. And this failure, which you can see for yourselves dur- 
ing residency, is emblematic of the even more shocking faO 
ures you can see when you leave behind nationality, a blue 
pill side effect, and take on the globe's medical problems. 

This brings me to a different, more personal part of my 
message. If you've agreed with me so far, then you'll see the 
vast promise of modern medicine and also the dismal situa 
tion ot our global village; more and more lor fewer and fewer. 
It's true in so many realms, but it's excruciatingly so in med- 
icine and public health. Martin Luther King, Jr., once said: 
"Of all the forms of inequality, injustice in health is the most 
shocking and the most inhumane." 

Taking the red pill is scary. There are those of )'ou who 
have popped the red pill but are now reaching for the ipecac. 
And who wouldn't? We live in a world of medical haves and 
have-nots, a world in which most ol the bottom billion have 
no modern medical care at all, a world in which current 
trends promise that the situation will only get worse during 
the early years of your medical practice. 

What are the boundaries of your world? Next year, the 
limits of your world w ill shrink to a hospital or two, and all 
you'll want to do when you leave the hospital will be to watch 
an action fihn yourself. Or hsten to some music. Or do what- 
ever it is that transports you out of the desert of the real. But 
in your heart, and in your practice, you know that most of the 
boundaries are ones we create ourselves. They are boundaries 
we erect in order to lessen our pain, not the pain of others. 

No other crop of young doctors will ever have the latitude 
and influence you will; no others have yet had the technology. 
In an essay every American should read, William Finnegan 
recently wrote in Harper's Magazine that "...every overweening, 
remorseless projection ol American power, every unfair trade 
rule and economic double standard jammed into the global 
financial architecture, helps erode the legitimacy of American 
a.scendancy in the eyes of the world's poor. This erosion is 
occurring throughout Latin America, Africa, Asia." 

I live and work in these places and I know Finnegan is 
right. The future of medicine is also jammed into this global 
financial architecture. It's why Partners in Health has had to 
fight tooth and nail to use the tools of modern biomedicine 
among the destitute sick in Haiti, since they do not consti- 
tute "a market." It's why we develop thermal sensors for 
Asian business commuters while another febrile continent's 
rigors go uncharted. 

Taking the red pill and seeing the world ot the sick as it is 
today — today being the global era of scientific medicine — 
leads us to painful choices. I'm not seeking to be Manichean: 
the choices before you are not between good and bad. 
They're between doing good and doing better. 

To do better, don't we have to take that red pill and 
fight? Your generation will have to answer that question. 
Because unfortunately, as Morpheus says, you and I have 
run out of time. Of course, the clock isn't really ticking on 
us. It's ticking on others. Again — how many people have 
died of treatable diseases during the time it took for me to 
give this talk? Especially on that febrile continent to which 
I return tomorrow? 

Allow me to leave you with two "take hcimc messages," as 
we say at HMS. First, apply the Golden Rule in your prac- 
tice — especially during that last admission, in the wee hours 
of the morning. Or to a particularly difficult or crabby 
patient. Could you ever care as much about her as you do 
about, say, your own mother? Could you ever love someone 
as much as you love yourself or your own child? The answer 
to these questions may well be certainly not, but at least the 
red pill pushes us to ask the question. 

Second, make home visits now and again. Don't buy the 
received wisdom about respecting boundaries. What's 
wrong with helping housebound patients wash their dishes? 
Or helping hutbound patients transform dirt floors into 
cement floors? Break down boundaries. Think outside the 
box. Do you want to wake up someday and discover that 
your life has become dim, without color? That you took the 
blue pLll? Even though your ectopic soul, stowed away, say, in 
your left axUla, forgotten and neglected, was exhorting you 
all along to make the leap, to take a chance? 

You know the questions. The answer is out there, and you 
will find it if you want to. 

Now you know. And knowing, as another action figure — 
G.I.Joe — was fond of noting, is half the battle. ■ 

Paid Farmer '90, the Maude and LiJUan Presley Professor of Social 
Medicine at HMS, is also executive vice president of Partners in Health. 

and the dignity of our sickest and most vulnerable patients. 




by Warren Kinghorn 


a character named Neil Perry, a promising 
student caught between his passion for 
theater and a domineering father's rejec- 
tion of his acting dreams. In the climactic 
scene right after Neil has starred in "A Mid- 
summer Night's Dream" and just before he 
commits suicide, his father threatens to 
remove him from school, adding, "We're not 
going to let you ruin your life! You're going to Harvard and 
you're going to be a doctor." Those words have haunted 
me; after all, 1 came to Harvard expHcitly to become a doctor. 

I suspect that the screenwriter of Dead Poets Society chose 
medicine and Harvard for that line because they represented 
for him, as for many, the confluence of one of our nation's 
most respected professions with one of our nations most 
prestigious schools. As we no\\' graduate from Har\'ard as 
doctors, that is the mantle we inherit. 

It would be easy for us to celebrate this fact blithely, to soak 
in the congratulations of others, to bask, however briefly, in 
the spotUght of status. But to do so would ignore the truth that 
for NeU Perry, as perhaps for many of us. Harvard and medicine 
would ha\'e been not a blessing but a curse, not freedom but 
imprisonment: imprisonment by the expectations of others. 

imprisonment by status and prestige and suc- 
cess, imprisonment inside market-driven 
selves that we only think we choose. 

To paraphrase the character of Mr. Keating 
in Dead Poets Society: business, medicine, and 
law may help us to sustain hfe, but \\"hat is it 
that we stay alive for? Is medicine to be both 
the means and the end of our existence? Are 
our hves' meanings tied up in securing presti- 
gious residencies and fellowships, winning 
the admiration of colleagues, pubUshing 
important papers, gaining tenure at places 
hke Har\'ard, or achie\ing a certain lLfest)4e or 
image? If so, are our patients means to those 
ends? If our Hves revolve around our patients, 
do aU others — our spouses and partners, our 
children, our friends and families — ^become 
secondary? Do our patients really benefit 
\\'hen we sacrifice all else for them? 

In answering these questions, we must 
face some controversial but disturbing find- 
ings. Seventy-six percent of surveyed residents in a recent 
Annals of Intamal Medicine study met criteria for "burnout," 
which was correlated with five self-reported suboptimal 
patient care practices. Suicide is a leading cause of preventable 
death among young physicians. Physicians' marriages are often 
marked by a "psychology of postponement" in which couples 
beheve that time, leisure, and intimacy will come at the never- 
reahzed next stage of the doctor's career. What is it, we must 
ask, about our healing profession — and about ourseh'es — that 
makes us vulnerable to such unhealthiness? 

The fact that we graduate from Harvard as doctors only 

magnifies the decisions we now face. Harvard has given us 

Business, medicine, and law may help us sustain life^ 

A young physician ponders the definition of success and the 
pressures on doctors outside the walls of Harvard Medical School 

tremendous opportunity; but opportunity 
and freedom are not the same thing. We 
have all been earmarked for success; today 
we run at the head of the academic pack, 
poised to extend our lead into the future. 
But being at the front brings with it an 
extraordinary pressure to stay there. We 
have the freedom at Har\'ard to achieve 
success, but do we have the freedom not to? 
Can we redefine or even reject Har\ard's 
conceptions of success? 

I hope that in our opportunity we will 
find freedom, and that our lives will model 
the healing that we will work so diligently 
to bring to our patients. We have worked 
hard to get here, and our celebration is jus 
tified. But in our celebration, let's remem 
ber that Har\'ard is great but impermanent 
and that our medical victories will be spec- 
tacular but only temporary. Let's therefore 
set our delight instead on those things that 
gleam so brightly that they render Harvard 
and medicme dull by comparison: the love 
of others, the beauty in others and in 
nature, perhaps even the love of God. For 
the ancient question still remains: what 
does it profit any of us if we gain the whole 
world and yet lose our very souls? ■ 

Warren Kingkom '03, who holds a master^ degree in 

theological studies, is undertaking a residency in psy- 
chiatry and internal medicine at Duhc llni\crsity 
Medical Center 

)ut what is it that we stay alive for? 





I by Rahul Sakhuja 

to say, I read previous graduation speeches, 
which commented on Harvard as the gateway to 
greatness or Harvard as an elevator to the upper 
echelons of society. And I realized that past 
speakers had missed a unique feature — that is. 
Harvard as the snooze button on life. Think 
about it: four, five, or fourscore years ago (if you 
got a doctorate too), we all faced the same 
option. We could continue in the real world or we could 
hit that snooze button on life.. .and go to graduate school. 
In fact, some of you — you shall remain nameless for the 

sake of any future patients in tfie audience — took tfiis analo- 
gy quite seriously, napping away your first two years. 

As in any fitful snooze, we often awaken with \'ivid 
memories. Permit me to share a few with you. The setting 
is the first day of our Patient/Doctor course and my first 
time seeing a patient while wearing a white coat. We head 
off down the hospital corridors, with our preceptor leading 
the way. We have a set of twins — Ryan and Brian — in our 
class and one of the twins is by my side. A month into 
school and I'm still not sure which twin he is, so I muffle 
his name: "M'ryan...hey!" I am armed with questions about 
quality, radiation, severity. 

I enter the room and begin. "Sir, I am a 
medical student. May I ask you some ques- 
tions about what brought you to the hospi- 
tal?" "No!" he snaps. I am stunned; it was 
actually a rhetorical question. My teachers 
had told me that I was good enough and 
smart enough. But, apparently, patients didn't 
like me. I had already failed. 

Another story, in a different setting — 
Guatemala, a couple of summers ago. I was 
sitting in the sunshine on the sidelines of a 
dirt soccer field, talking wdth Maria. A com- 
munity activist, Maria was a local hero. Her 
husband had abandoned her when she was 
pregnant with Juan. .*\fter giving birth, she 
became \iolently ill and was diagnosed with 
HIV. But she received a second chance — she 
recovered. Then her worst nightmare came 
true: her son became ill. He, too, had HI\". I 
remember Maria saying, "Our people can't 
handle this; the virus is too strong." 
Yet Maria began working with a group of women to 
bring treatment to the community. Through her work, she 
saw a light in people's eyes, one that some never witness. 
Maria died recently. But, before she died, she said: "I Ued. 
Our people can handle this but, right now, I no longer can. 
The virus is too strong." 

Now, our nine minutes are up. The snooze is o\-er. Okay, 
okay — for those of you going into ophthalmology or derma- 
tology or radiology, you have another nine minutes. As for 
the rest of us, we are waking up. 

If you thought it was hard getting up for nutrition class, 
try waking up to life. The concerns are much greater — global 

As in any fitful snooze, we often awaken with vivH 


An HMS graduate receives a wake-up 
call to his new life as a doctor 

HI\', medical errors, no access to health insur- 
ance. And, yes, I am ner\'ous. Before, when we 
failed, there was not much at stake; now, when 
we fail, we risk human h\es. 

In the Patient/ Doctor One course, I failed. 
My patient didn't even let me into the room. 
But I watched Aimee take a history and I 
watched whichever twin that was take one 
as well. With their help, I learned to help 
patients. As part of this group, I achieved what 
I could not have accomplished alone. When 
Maria reflected on the impact of AIDS on her 
community, she, too, thought she would fail. 
And while she did not survive individually, by 
joining with others she was able to tackle diffi- 
cult problems in an enduring manner. 

While the problems and responsibilities 
that we face are much greater than those of 
the Patient/ Doctor course, the group we are 
about to join — doctors, dentists, and scien- 
tists — is much bigger and more powerful. 

I look around today, and I am less ner\-ous. 
When I am sick, I want this group around. 
When tough problems loom over me, I want 
this group around. It's been a wonderful 
snooze. I, for one, am glad that I had you all by 
my side. It has been a privilege to learn with 
you — and from you. It will be a privilege to 
lead alongside you. It is inspiring to wake up 
to this new life as a part of this group. ■ 

Rahul Sakhuja '03 is undertaking an internal medicine 
residency at Massachusetts General Hospita 





Today, you stand before family, friends, teachers, 
and colleagues, ready to become physicians and 
dentists. For two thousand five hundred years, 
since the time of Hippocrates, doctors have taken 
an oath to affirm a commitment to their profes- 
sion. This oath has served as both a tribute to 
their teachers and as a contract with their com- 
munitY In this spirit, the Class of 2003 has cre- 
ated an oath that draws upon elements of oaths 
both recent and ancient. I now invite you, as a 
class, to share in this tradition and to articulate 
the ideals and principles that will guide vou in 
the years ahead. 

The following medical degree recipients graduated 
with honors or special awards: 

Ramy Amin Arnaout, cum laude 
The Immunity Hypothesis: An 
Alternative Explanation for the 
Dynamics of the Biphasic Decay 
in Viral Load in HAART-Treated HIV-1 
Infected Individuals 

Otter Quaking Aspen 

National Medical Fellowships 2003 
Rolph W. Ellison Memorial Prize for 
outstanding academic performance, 
leadership, and social consciousness 

Otter Quaking Aspen, Teran Wilson 
Colen, Jennifer Yu-Fe Lin, Chiadi Ericson 
Ndumele, and Kerri Akaya Smith 

The Multiculturalism Award to the 
senior in each Academic Society who 
has done the most to exemplify and/or 
promote the spirit and practice of 
multiculturalism and diversify 

Michelle Faith Benger-Merrill 

Bemy Jelin '91 Prize to that senior who 
most demonstrates overall academic 


Upon mv honor, by all that 1 hold most sacred, 1 pledge myself to the sendee of humanity. 

To my Patients: 

I vow to care for those m need and strive to alleviate suffering 

1 will honor and protect the confidences entrusted to me. 

I will recognize the importance of religious and spiritual beliefs in the context of health. 

I will empower my patients to make sound decisions for their health and well-being. 

I will respect my patients dignity and autonomy both m living and in dying 

To my Community: 

I embrace my duty to society. 

1 will work to promote health and prevent disease 

I will support efforts to extend health care access to everyone. 

I will address the social and environmental problems that impact the 

health of my patients 
I will not use my skills contrary to the laws of humanity, even under duress. 

To my Colleagues: 

I promise to maintain the integrity and noble traditions of my profession. 

I will honor with respect and gratitude, all who teach me this art. 

I will work m diligent and honest collaboration with my fellow practitioners 

to uphold the highest standards of patient care 
I will teach and advance the art and science of medicine with kindness and purpose 
I will practice my profession with honesty, dignity, and compassion. 

To Myself 

I commit myself to the pursuit of knowledge and to a lifetime of learning 
I will acknowledge my limitations and mistakes so that I may learn from them. 
I will keep watch that my ambition and curiosiV}' serve my patients and not my ego. 
I will maintain my own health and well being, and the well being of those close to me. 

so that 1 may uphold these responsibilities. 
I will ensure that, above all, the health of my patients is my first concern. 

Today, with the support offamih and friends, peers and manors. I pledge to fulfill this oath to 
the best of my abilit}' and judgnient. as 1 dedicate myself to the art and practice ofnKdicine 




F If ^ ^i^V 

1 -lili M^^ S 


excellence with a career interest in 

Potentiation Is Diminished but Present 


Dediatrics, oncology, international 

in fiippocampal Slices from a-CaMKII 


leolth, or psychiatry; the Arnold P. Gold 

Mutant Mice 


Foundation Humanism in Medicine Award 


to a graduating medical student who 

Karen Joan Ho 


consistently demonstrates compassion and 

Richard C. Cabot Prize for the best paper 


empathy in the delivery of care to patients 

on medical education or medical history: 
Bacteriophage Therapy for Bacterial 


Andrew Ernest Bennett, 

Infections: Rekindling a Memory from 

magna cum laude 

the Pre-Antibiotics Era 

Leon Reznick Memorial Prize for 

Emanuol M. Maverakis, 

excellence and accomplishment in 

Melody Yen Hou, cum laude 

summa cum laude 

research: Broadband Adiabatic 

Molecular Mechanisms of FShI Beta 

Determinant fiierarchies. Immunologic 

Mixing and the Structure of the SH3 

Gene Regulation by GnRfi 

Tolerance and Exhaustion, Molecular Mimicry, 


Domain in CD2BP1 by Solution 

T Cell Competition, Public and Private 

NMR Spectroscopy 

Leonid Izikson, magna cum laude 

Determinants, and Their Role in Autoimmune 

Chemokine Control of Th 1 -Mediated 

Susceptibility and Disease Progression 

Aimee Marie Crago, cum loude 

Autoimmune Disease 

VEGF Is an Autocrine Survival Factor 

John Michael McWillioms, 

for Metastatic Carcinoma Cells 

Maurice Vernon Jeter, Jr. 

magna cum laude 

Society for Academic Emergency 

Use of Basic Clinical Services and Mortality 

Jason Alexander Efstathiou, cum laude 

Medicine Excellence in Emergency 

Among Uninsured Near-Elderly Adults 

Novel Approaches for the Treatment of 

Medicine Award to a senior medical 

Endometriosis in a Murine Model 

student who has demonstrated excellence 

Megan Macklin Moore, cum laude 

in the specialty of emergency medicine 

Perinatal Predictors of Atopic Dermatitis 

Anna Flattau 

Occurring in the First Six Months of Life 

Robert H. Ebert Primary Care 

John Curtis LaMottino 

Achievement Award for excellence 

Kurt Isselbacher Prize to the senior 

Chiodi Ericson Ndumele, 


and outstanding accomplishments in 

demonstrating humanitarian values 

cum laude 

the field of primary care medicine 

and dedication to science 

Differences in the Characteristics, 
Treatment and Outcomes of Trial and 


Amy Marie Gillis, cum laude 

Benjamin Leader 

Non-Trial Patients Receiving Thrombolytic 


Magnetic Resonance Imaging of Gly- 

Harold Lomport Biomedical Research 

Therapy After Acute Myocardial Infarction 

cosaminoglycan Distribution in Cartilage 

Prize for the best paper reporting original 

(dCEMRICj: Verification of Biophysical 

research in the biomedical sciences: 

Rahul Sakhuja 

Basis and Clinical Studies 

Formin-2, Polyploidy, Hypofertility and 

The Ceroid S. Foster Award in recognition 


Positioning of the Meiotic Spindle in 

of contributions to the student body by 


Sara Naomi Goldhober-Fiebert 

Mouse Oocytes 

virtue of serving on a student-faculty 

Rose Seegol Prize for the best paper on 
the relation of the medical profession to 

committee including but not limited to the 

Michelle Ann Lee 

Committee on Admission 


the community: Randomized Controlled 

James Tolbert Shipley Prize for excellence 


Community-Based Nutrition and Exercise 

and accomplishment in research: (1) 

Jenny Ying Xin Sun, cum laude 

Intervention Improves Glycemia and 

Endogenous Patterns of TGFb Superfamily 

Transcriptional Control of the IL- 1 3 


Cardiovascular Risk Factors in Type 2 

Signaling During Early Xenopus Develop- 

Gene in CD4+ T Cells 


Diabetic Patients in Rural Costa Rica 

ment and (2) Timing of Endogenous 

Activin-Like Signals and Regional Specifi- 

Andy Tsai, cum laude 

Mary Elizabeth Gordon 

cation of the Xenopus Embryo 

Coupled Multi-Shape Model for Medical 


Henry Asbury Christian Award for notable 

Image Segmentation: A General Frame- 

scholarship in studies or research: The 

Percy Po-Yih Lee, magna cum laude 

v^ork Utilizing Region Statistics, Edge 


Contribution of Nitric Oxide to Exercise 

The Ro/e of Neuropilin- 1 in Tumor and 

Information, and Information-Theoretic 

hlyperemia in the hiuman Forearm; the 

Developmental Angiogenesis 


New England Pediatric Society Prize to 

the senior who in the opinion of peers 

Wilson Joe Liao, magna cum laude 

David Allen Walton 

and faculty best exemplifies those qualities 

Array Comparative Genomic Hybridiza- 

The Community Service Award to the 

one looks for in a pediatrician 

tion of Metastatic Melanoma Detects 

senior who has done the most to exemplify 

Gene Copy Number Changes and May 

and/or promote the spirit and practice 


Heather Lyn Hinds 

Provide a Model to Predict Response to 

of community service 

Dr. Sirgay Sanger Award for excellence 

11-2 Immunotherapy 

and accomplishment in research, clinical 

Jonathan Daniel Wassermon, 

investigation, or scholarship in psychiatry: 

Jennifer Yu-Fe Lin, cum laude 

cum laude 


(1) Essential Function of o-CaMKII in Neu- 

SV40 Large T Antigen-Mediated Dephos- 

The Role of FOXO Proteins in Transduction 


rotransmitter Release at a Glutamatergic 

phorylation of pi 30, a Retinoblastoma 

of Insulin Receptor Signaling and 


Central Synapse and (2) CA 1 Long-Term 

Family Protein 

Mediation of Cell Growth and Survival 



DAY 200 


1 \ 

■ 'i 

^r ' '^'i^ 

ip^i»4 k 






Physicians weigh in on the risks of action — and inaction- 
in the smallpox vaccination debate 


by Courtney Humphries 


of controversy, especially in Boston. 
In the 1720s, Cotton Mather and 
Zabdiel Boylston were the targets 
of threats and ridicule when they 
tried to introduce a new method of 
inoculation to the colonies. In 1901, 
Boston's last outbreak of smallpox 
prompted a door-todoor vaccina 
tion campaign that sparked protest 
and charges that public health offi 
cials were attacking civil liberties 
by forcibly vaccinating the poor. One 
hundred years later, the threat of 
bioterrorism has spurred a new 
vaccination campaign and similar 
ambivalence on the part of the 
public and the medical community 
alike. The 2003 Alumni Day sympo- 
sium, "Smallpox: Proxy and Probe," 

Leader Bill Frist '78 received his smallpox vaccina- 
tion in March 2003. A transplant surgeon, Frist 
also undervs^ent training to administer the vaccine 
in the event of an outbreak. 

demonstrated how the reeent smallpox scare has dredged 
up old controversies over civil liberties, public health, and 
resource allocation. 

As director of Georgia's Di\ision of Public Health, Kathleen 
Toomey 78 has witnessed firsthand how the 2001 attacks 
changed pubUc health in the United States. The threat of 
bioterrorism has brought medical and pubUc health profes- 
sionals into a new role as first responders to terrorism. The 
decision to \'accinate them for smallpox this year was largely 
based on the vaccine's availabiht); Toomey said, rather than on 
e\idence that the \'irus would actually be used as a bioweapon. 

The arguments that officials like Toomey have faced 
from the public are familiar in the history of smallpox in 
the United States, noted Allan Brandt, the Amalie Moses 
Kass Professor of the History of Medicine at HMS. Boston's 
controversial vaccination campaign at the beginning of the 
1900s led to "what may be the most important public 
health litigation," Brandt said, the case oijacobscn v. Massa- 
chusetts, in which the court determined that there is a limit 
on individual rights when it comes to public health efforts 
for the common good, such as mandatory vaccination. But 
the increased power of the state to act in the interests of 


by Kathleen Toomey 


the anthrax attacks that followed, national 
concerns about the potential for other 
bioterrorism threats have highlighted the 
role of public health as a fundamental 
component of our public safety and national 
homeland security systems. For much of the 
past 18 months, in fact, nearly 90 percent of 

my time as a state health officer has been devoted to activi- 
ties related to emergency preparedness and bioterrorism 
response, with the past few months largely focused on our 
state smallpox initiative. 

The anthrax attacks are the only examples of bioterrorism 
that many people know. Yet those letters, with their alerting 
messages and visible powder, were anomalous compared 
with nearly any other conceivable bioterrorism scenario. 
Unlike other terrorist acts, a bioterrorist attack likely will 
not have a single focus or an identified location that is the 
"site" of the attack. Instead, recognition of bioterrorism will 
occur as it does tor other, naturally occurring diseases or out- 
breaks. A patient with a specific disease or unusual constel- 

lation of symptoms will be reported to 
pubUc health officials by a cUnician, 
and public health staff will carry out an 
im'estigation. The initial case of anthrax 
in Florida was identified in just that 
manner — recognized and reported b\' 
an astute clinician who communicated 
to his local public health department 
and triggered the notifiable diseases 
surveillance and response systems. 

Since the time of the anthrax in\'esti- 
gations, much has been written in the 
popular press about the perilous state 
of the nations neglected public health 
infrastructure. But labeling the acti\i- 
ties that reflect this interaction between public health and 
the medical community as the "pubUc health infrastructure" 
is misleading. Public health cannot work in isolation from 
the broader medical community, and the success of our 
bioterrorism response will depend on the \ital interaction 
between public health and the medical care system. 

Se\-eral years ago in Georgia, we in\'estigated an unusual 
outbreak of E. coU 0157 H7, which came to our attention when 
a hospitalized child with hemohtic uremic s)Tidrome was 
reported to the state health department. Subsequent investi- 
gations and tracebacks eventually identified 26 culture -con- 
firmed cases of £. coli and many additional suspected cases, 
with the initial transmission occurring in an inadequately 



public health has to be balanced by ethical standards, 
reasonableness, and a ratio of risks to benefits. 

Translating such ideas into pohcy is difficult in the case of 
smallpox, noted Kenneth Shine '61, director of the RAND 
Center for Domestic and International Health Security. Shine 
pointed out that the Bush administration's target of vaccinat- 
ing 500,000 health providers has resulted in only about 36,000 
\'accinations so far. Why has the campaign been so problem- 
atic? The initial target was moti\'atcd by political pressures 
rather than sound models. Shine said, adding that some of the 
risk assessments used to create the policy o\'erestimated the 

spread of a smallpox outbreak. .And, as Toome)' pointed out, 
the smallpox vaccine "remains the most dangerous inocula- 
tion e\'er routinely used," with about one to three deaths per 
million vaccinations and many more cases of comphcations. 
"The case tor the health pro\ider \-accination was not made 
compeUingly," said Shine, addmg that he believes \'accinating a 
smaller number of health providers would be enough to ensure 
an effective response to outbreaks. In the future, he added, 
"We must insist that it's the data driving the decisions." ■ 

Courtney Humphries is a science writer for Focus. 


A public health leader examines the political 
costs of vaccinating against an eradicated killer 

chlorinated pool at a water park. This 
outbreak was not a bioterrorism inci- 
dent, but the manner in which the cases 
were identified — with an initial case 
leading to an extensive investigation 
involving many pubhc health officers and 
health care providers throughout Geor- 
gia and other states — more accurately 
reflects how a covert bioterrorist attack 
would likely be identified and tracked. 

.Although virtually any biologic agent 
or toxin could be used in a bioterrorist 
attack, several — including brucellosis, 
tularemia, plague, and anthrax — have 
been studied for their potential use in 
germ warfare. The possible use of small 
pox as a biologic weapon has been of 
special concern, however. Smallpox, 
caused by the variola virus and a scourge 
of mankmd for centuries, was declared 
eradicated worldwide in 1980 after an 
intensive global vaccination campaign. 
The last case of smallpox in the United 
States occurred in 1949, but routine vac- 
cinations continued until 1972. 

The smallpox vaccine, a live virus 
vaccine using vaccinia virus, remains the 
most dangerous inoculation ever rou- 

TAKING NO CHANCES: Investigators in protective suits stand outside the Hart 
Senate Office Building on Capitol Hill last September, following the finding of 
a suspicious note with a reference to smallpox on it. The building reopened 
shortly thereafter. 


mallpox dropped off the media radar screen 

Our final decisions were framed by our assessment that 
we could not risk a single bad outcome from the vaccine pro- 
gram. To accomplish that goal, we felt the need to balance 
our critical smallpox preparedness efforts with frank 
acknowledgement of the vaccine's risks and the reportedly 
low probability of an imminent attack. Without a change in 
intelligence to suggest that a smallpox attack was likely, we 
chose to implement an appropriately aggressive but careful 
plan that emphasized education and response preparedness 
rather than the total number of vaccinees — a plan that 
would ensure an effective response but with less risk to the 
health and safety of participants. 

The decision about how to proceed was one of the most 
difficult I have made during my tenure as state health officer, 
in part because my staff and I recognized that the price of 
failure would be high. In the first step, we would focus on 
the Atlanta area, vaccinating public health response teams 
and hospital staff from the regional trauma centers, the hos- 
pitals that had been working most closely with pubhc 
health on other emergency response activities. Next, we 
would vaccinate public health and trauma center staff from 
outside Atlanta. In the final phase, we would offer vaccina- 
tion to staff from any other wilhng hospitals in the state. 

We tightened the criteria for screening beyond those rec- 
ommended by the CDC and at each step included multiple 
screens of participants to ensure that neither they nor their 
family members had any health conditions that might put 
them at risk for complications. After each step, as we 
expanded to a larger cohort of vaccinees, we included a com- 
prehensive evaluation of all our activities — the vaccination 
procedures, the public's and potential vaccinees' under- 
standing and acceptance of our educational messages, and 
an assessment of other unpredicted events — to allow us to 
constantly refine the vaccination program and our o\'erall 
emergency response plans. 

The manpower requirements to implement this focused, 
careful plan were enormous, with the first step alone con 
suming hundreds of hours of staff time to develop materials, 
train trainers, train participating staff, screen vaccinees, set 
up clinics, and evaluate the processes to improve our proce- 
dures. We mailed bioterrorism educational materials with 
detailed information about the smallpox vaccination pro 

gram to every licensed physician, as well as other health 
practitioners, in the state. We recruited several infectious 
disease experts to train physician consultants in aU parts 
of the state to ensure that we had clinical expertise readily 
available if we identified any possible vaccine-related com- 
plications. I met with many of the medical and hospital lead- 
ers in the state as part of these preparations to make certain 
that they understood the importance of our efforts and to 
gain their support for collaborative planning. 

Our voluntary vaccination program was just one piece of 
our preparedness efforts. Although hospitals could choose 
not to vaccinate their staff, we emphasized that they had 
to continue to work with us to develop and test our joint 
emergency response plans. My message to the hospitals 
was clear: the choice to vaccinate was voluntary, but work- 
ing with us to develop a statewide emergency response 
system was mandatory. 

The media played a significant role in this campaign, 
just as they figured prominently in the way our nation 
perceived the risks around the anthrax letters and contin- 
ue to frame the public response to bioterrorism. I often 
learned about incidents of potential public health impor- 
tance from CNN — headquartered in Atlanta — long before 
reports came to me through traditional public health com- 
munication channels. 

Because of the intense media scrutiny of the smallpox 
vaccination program nationally, and significant public 
interest in the program in Georgia, I was concerned that 
our smallpox efforts be accurately portrayed to the public, 
reflecting our considerable efforts to balance preparedness 
with adequate protections for participating staff and their 
families. After spending several hours with a reporter dis- 
cussing our plan, I was disappointed the next day to read 
the headline in our local newspaper: "Georgia Bucks Bush's 
Plan," describing our efforts as "conservative." Subsequent 
press coverage was relatively balanced, and our plan moved 
forward as we had hoped. Our labor-intensive efforts paid 
off in that we documented no adverse outcomes and the 
collaborative process generated considerable good will 
from the broader medical community statewide. 

But in other states, some public health and military pro- 
grams reported unexpected cardiac complications, possibly 



for an unanticipated reason — SARS had emerged. 

related to the recent smallpox \'accinations; pericarditis and 
myocarditis, as well as several deaths from myocardial 
infarction among public health staff. After these comphca 
tions were reported, several states suspended their vaccina 
tion programs until more information could be gathered 
about the actual risk for cardiac compUcations from the 
smallpox vaccinations. In Georgia, after long debate among 
public health leaders, we decided to continue our vaccina- 
tion program. Using the same cautious approach we had 
taken pre\'iously, we added more stringent cardiac screening 
criteria than those required by the CDC. Since we had built 
natural lulls into the state's vaccination program to accom 
modatc evaluation, we were able to adjust our procedures 
without suspending our program. 

The newspaper headline following our decision to contin- 
ue vaccinating was as surprising as the first had been: "Geor- 
gia Pushes Ahead with Smallpox Vaccinations Despite 
Risks." With the same careful, balanced approach in carry- 
ing out what we still consider to be a strong, science-based 
program, our efforts, initially perceived as tentati\'e, were 
now considered reckless. 

That was the final news report about our smallpox pro- 
gram. Smallpox dropped off the media radar screen for an 
unanticipated reason — SARS had emerged as the health 
concern that dominated the press and the pubUc's attention. 
But the recognition of SARS was also a wake-up call for 
those of us working in pubhc health. Whereas our smallpox 
plans — from clinics to operational protocols for quarantine 
and isolation — had been theoretical and seemed unlikely 
ever to be implemented, now abruptly we were confronted 
with the reality of an actual emerging infection that required 
us to implement these plans with some urgency and with 
unprecedented infection control implications. 

Fortunately, we ha\'e now been able to broaden our con 
tinuing smallpox vaccination efforts to ensure that the 
education, training, and planning we are developing joint- 
ly with hospitals and the medical community are applica 
ble to any infectious agent or any emergency event. And we 
have incorporated SARS-specific information, in addition 
to the intensive smallpox vaccination guidance, into our 
vaccination training as we wind down this phase of our 
smallpox vaccination program. 

We learned much from this experience, and, 1 behe\'e, 
gained the respect of our partners in the medical community 
by our careful efforts to ensure that our policies and plans 
were based on science, not pohtics. The acti\-e participation 
of the academic and chnical medical communities in this 
process has been a model for how other pubUc health pro- 
grams must function in the Riture. We recognize the impor- 
tant role the media played in framing our efforts. Proactive 
communication and coordination with the media will be 
considered an essential part of our overall preparedness plan- 
ning, to ensure accurate and responsible reporting at a time 
when this information may be critical to the pubhc's health. 

I want to frame this discussion with yet another per- 
spective, by quoting Brian Strom, chair of the Institute of 
Medicine committee charged by the CDC with evaluating 
the national smallpox efforts. His thoughts from a recent 
interview certainly reflect the ambivalence all our staff 
felt as we planned and implemented this smallpox pro- 
gram; "From a public health point of view, it makes no 
sense to give a vaccine that kills people against a disease 
that doesn't exist. This is not a public health campaign, it's 
a biodefense campaign." 

This will not be the final time that we — public health 
and the academic and clinical medical communities — will 
be confronted with these challenges, particularly as we 
continue to play an ever-increasing role in our nation's 
homeland security and bioterrorism prevention efforts. We 
will never be able to anticipate every possible threat or pre- 
pare for e\ery possible contingency. But we can and should 
use these programs as opportunities to strengthen and sus- 
tain both the overall health system and the crucial inter- 
face between public health and medical care. We must 
ensure that we are able to mount an agile and effective 
response regardless of the threat that confronts us — 
whether it is smallpox, anthrax, SARS, pandemic influen- 
za, or E. coU. If we are not aggressive about our commit- 
ment, ironically, we will have squandered the great 
opportunity to improve our health system that this war on 
terrorism has provided us. ■ 

Kathleen Toomcy 78 is director of the Division of Public Health of the 
Georgia Department of Human Resources. 





A medical historian draws parallels between today and 1721, when Za 

by Allan Brandt 


attacks that followed have fundamentally reori- 
ented our public health priorities, the way we 
think about medicine and science, and our views 
on social and medical uncertainty. The potential 
threat of smallpox, in particular, raises urgent 
questions about how societies will mediate a 
range of concerns in the coming century, includ- 
ing our responses to bioterrorist threats. Smallpox also 
has a deep, historical connectedness to earlier times, 
when our forebears faced the same disease and considered 
overlapping questions of how to proceed in the face of 
phenomenal uncertainties, especially as they relate to 
issues of health and disease. 

It wasn't supposed to be this way. In 1980 the World Health 
Organization announced the eradication of smallpox. It 
was one of the greatest public health triumphs in history 
and marked a moment of incredible hopefulness about the 
possibility of stamping out many infectious diseases. Now 
that we've eradicated smallpox, people asked, how can we 
eliminate malaria? How might we eradicate tuberculosis? 
These optimistic questions no longer occupy center stage 
as we face today's threats of bioterrorism. 

Throughout its centuries-long history, smallpox has 
sharply defined tensions between individual rights and the 
collective good of society. It raises issues of safety and effi- 
cacy, the rights of indi\'iduals, the responsibility of the 
state, and our obligations to each other. These are the same 
issues that were vigorously, sometimes violently, confront 
ed in Boston in 1721. 

when smallpox returned to Boston in the spring of that 
year, the city v\'as already intimately famihar with the disease. 
Many of those who had journeyed to the colonies had done so 
in part to escape smallpox and other endemic diseases of 
Europe. But while the New England settlements and the 


colonies that followed often suffered periods 
of intense smallpox epidemicity, they did not 
experience an endemic smallpox as it existed 
in Europe. The disease especially wreaked 
havoc on indigenous populations in New 
England in the seventeenth and eighteenth 
centuries. During the first century of Euro- 
pean settlement, historical demographers 
estimate, as many as 90 percent of the region's 
indigenous people died of smallpox and other 
infectious diseases brought by colonists. 

Whene\'er smallpox appeared in a cit)' or 
town in the early eighteenth century, as much 
as one quarter of the population tended to die. 
Yet those \\'ho lived through the disease had life- 
time immunity, a fact understood at the time. 
George Washington had contracted smallpox 
during a visit to the West Indies, for example, 
and it was widely knowTi that he would not be 
vulnerable to any subsequent epidemics. 

In the spring of 1721, a boat sailing from the 
West Indies carried seamen with likely cases 
of smallpox. Even though the boat was quar- 
antined in Boston Harbor, some crew mem- 
bers disembarked, sparking an epidemic. A leading cleric in 
Boston, Cotton Mather, had learned of the procedure of var- 
iolation from his slave Onesimus. This inoculation involved 
inserting pus from a smallpox patient into a healthy indi- 
\'idual through a scarification process that would confer a 
mild case of the disease and then immunity to those who 
had been inoculated. 

Mather began to advocate for a major inoculation cam- 
paign by sending a letter to all the physicians of Boston. Only 
one responded, and not a particularly eminent one at that: 
Zabdiel Boylston, who, following Mather's lead, became an 
advocate for smallpox inoculation. Boylston inoculated his 
six year- old son, his two sla\'es, and then himself. I often 
invite my students to consider the moment when Boylston 
stood above his young son, making the decision to inject Uve 
smallpox virus into his child's bloodstream, a procedure not 
well understood at the time. 

Ironically, although Mather supported inoculation, the 
organized medical profession in Boston, led by William 
Douglas, opposed it aggressively. "Many have died from the 
infection received from the inoculator," Douglas wrote to 


}| Boylston took a momentous gamble by inoculating his own child with the smallpox virus 

Mather. "Their deaths in great measure He at 
the inoculator's door." Mather's house was 
bombed, and the perpetrator left a note: 
"Cotton Mather, you dog, damn you! Ill 
inoculate you with this, with a pox to you!" 

Perhaps Mather was able to ad\'0cate for 
smallpox inoculations precisely because he 
v\'as not a physician. The \'ery idea of a physi- 
cian deUberately introducing a disease into 
healthy indi\1duals represented a new con- 
cept that the relatively weak and poorly orga- 
nized medical profession in Boston simply 
wasn't prepared to accept. 

By the late summer of 1721, in one of the 
first instances of intensive pubhc health sur- 
veillance, Boston officials began to compare 
the number of cases among those who had 
been inoculated with those who had not. Of 
the 6,000 people infected while uninoculated, 
14 percent had died. Of the 300 people whom 
Boylston had inoculated, only 2 percent had 
died. As a result, inoculation soon became 
widespread. But physicians still feared that 
inoculating in anticipation of an epidemic 
could imphcate them in the spread of the virus. 
This fear would persist until after 1796, when 
the noted physician Edward Jenner carried out 
his first experimental vaccination, which 
pax'ed the way for the remarkable transition 
from inoculation with the actual smallpox virus 
to \'accLnation with the related cowpox \irus. 

Throughout the eighteenth century and 
into the nineteenth century, the debate con- 
tinued about how many cases of smallpox 
were needed to justify inoculation. In fact, 
many states passed laws banning inoculation, 
except during times when the disease reached 
an exphcitly determined le\'el of epidemic at 
which they believed that the risk/ benefit 
ratios shifted significantly. 

By the early t\\'entieth century, the govern- 
ment was often stepping in to mandate pubhc 
health programs and vaccinations. Again, 
Boston figured prominently in the story. In 
1905, Henry Jacobsen, a man from Cambridge, 

dangers, Ed>vard Jenner's smallpox vaccine was eventually 
embraced as less risky than the deadly virus itself. 



refused to submit to the mandatory smallpox vaccine being 
administered in Boston at the time. The case went to court and 
led to what may be the most important public health litigation 
in the history of the modern United States: Jacohscn v. Massachusetts. 

In his decision, Justice Joseph Harlan specified four consti 
tutional standards that became the basis for how, within our 
democratic society, we tend to balance individual rights with 
the social good. These requirements were: a public necessity; a 
reasonable means to prevent or ameliorate the threat; propor- 
tionality in the sense that the burden could not be dispropor- 
tionate to the public health benefit that was expected; and the 
assurance that the subjects of a particular intervention would 
not be expo.sed to any undue heailth risks. 

These criteria illustrate a deep sense of continuity between 
historical approaches to the problem of smallpox and infec- 

tious disease and our own contemporary attitudes. The threat 
of bioterrorism is now forcing us to confront a series of compli- 
cated and difficult ethical questions. 

Most of us who received smallpox vaccines as children were 
inoculated too long ago to have any remaining immunologic 
respon,se. And most Americans were born after smallpox vacci- 
nation was discontinued in 1972. We are now vulnerable in the 
way that indigenous peoples of North America were \-ulnerable 
in the sixteenth and seventeenth centuries. 

No single algorithm can tell us how to approach disease pre- 
vention in a democratic society. But we need to create better 
opportunities for collaboration and cooperation. Vaccination 
programs test our ethics, our sense of community, and our 
essential notions of the collective good. We live in a culture 
of intense individual rights, with an often fractured sense of 


by Kenneth Shine 


anthrax attacks of 2001, we thought that 
it took at least 10,000 to 15,000 organisms 
to cause anthrax in humans. But the 
attacks showed us that a much smaller 
inoculum could cause people to become 
sick. ■ The spread of the West Nile virus 
throughout the United States arose in 

part from a failure in mosquito abatement on the East 
Coast. But the real surprise was the appearance of West 
Nile in the blood supply and in organ transplants. 

And the smallpox vaccine, prepared with a live virus, has 
only recently been associated with myocarditis and peri- 
carditis — complications never before recognized with vac 
cination. Such trickery reminds us that we need to maintain 
a substantial amount of humility in confronting infectious 
organisms, both when they occur naturally and when they 
are manmade. 

We must also recognise that health policies may cause 
unintended consequences. Public health officials in north 

ern Virginia are predicting an increase 
in teenage pregnancies, for example, 
because the people providing teenage 
pregnancy counseling were suddenly 
called on to develop a smallpox vacci- 
nation program. Those responsible 
for monitoring sexually transmitted 
diseases also were required to get 
involved in the smallpox program, 
resulting in a lack of follow-up in dis- 
ease monitoring in many jurisdictions. 
These are just two examples of the 
unintended consequences of health 
policies, particularly when those poli- 
cies are unfunded stopgap measures; 
although federal money has been allocated to states to sup- 
port public health, the smallpox program itself was not 
specifically funded. 

Public health policy is intimately related to politics. PoU- 
tics, public pohcy, and health pohcy are constantly interact- 
ing in ways that are difficult to balance. If we want volun- 
teers to submit to a \'accine, for example — particularly when 
they are healthy, intelligent, and weU educated — we need to 
develop a better case than the one that has been made thus 
far for smallpox. Although the Bush administration's original 
plan called for 500,000 health providers to be vaccinated, 
only around 36,000 have been inoculated to date. 



collccti\'e good and collective action. We dso live in an age of a 
declining public health infrastructure, rapid changes in profes- 
sional \'alues and notions of professional responsibility, and a 
powerful, sometimes irrational, belief that all risks of medicine 
and public health can and must be banished. 

The debate over vaccination in the United States and in 
other countries is today, as it was in 1721, a powerful reminder 
that any medical intervention is only as effective as our ability 
to deliver it in timely ways that are civically and consensually 
understood. W'c need to do much to educate both health care 
professionals and the public. 

Collective perceptions of risk and benefits are forged in 
historically specific ways; What is the threat? What are the 
alternatives? Who will be at risk from any particular inter- 
vention? How arc these risks understood and shared? The 

adverse consequences of vaccinations are not constant; 
they're forged in a culturally specific moment that shifts. One 
of the many terrible consequences of terrorism is that it 
disrupts our most rational and thoughtful approaches to 
maintaining the public good. It also disrupts our capacity for 
planning and for allocating resources fairly. 

In this post-September 11 age, it will be important to resist 
powerful tendencies to act on small and unsubstantiated 
fears, while simultaneously resisting our capacity to deny 
them. When public health is caught between the Scylla of 
hysteria and the Charybdis of denial, the public's health is the 
ultimate casualty. ■ 

Allan Brandt, PhD, is the Amalk Moses Kass Professor of the History 

of Medicine at HMS. 


The smallpox virus challenges policymakers to 
weigh hypothetical risks against medical realities 

Smallpox is only one of a number 
of potential threats. Anthrax, plague, 
and tularemia are all endemic in this 
country. We have antibiotic treat 
ments and vaccines for all three of 
these diseases, but the vaccines are 
not very good. The anthrax vaccine 
requires six injections over 18 
months. Just imagine how complex it 
would be to undertake a major 
anthrax vaccination program in a 
large population. 

Bioterrorists, in fact, could use many 
\'iruses, but smallpox would make a 
particularly effective weapon because 
it is highly contagious; plague can be 
communicated from person to person 
in its pneumonic form, but tularemia 
and anthrax are not contagious from 
human to human, as far as we know. 
On average, the mortaUty of smallpox 
outbreaks around the world has been 
in the range of 30 percent, although many of those deaths 
occurred before some of our current antibiotics were available 
to treat secondary infections. 

Clearly, the smallpox virus can be weaponized; the 
Russians spent huge amounts of money to this end. But 

VIAL CHOICES: The threat of bioterrorism has forced officials to balance the risks 
of a problematic vaccine with the vulnerability of an unvaccinateci population. 

there is an effective vaccine, and enormous political pres- 
sure in the aftermath of September 11 and the anthrax 
attacks has been mounted to respond to the potential 
smallpox threat. Policymakers need reassurance that they 
will not be held responsible for a catastrophe that they 



mallpox weaponization is a risk, but the 

might have prevented. Therein Ues the dilemma, where 
health and politics come together. Political leaders in this 
kind of situation desperately need to be able to say, "We 
did everything that could have been done." 

We should remember several important points about 
smallpox. The first is that after active exposure — even if 
it's to aerosolized smallpox — people are not contagious for 
seven to seventeen days, creating a window for immuniza- 
tion. We know that vaccination has some effect within the 
first three to four days either to ameliorate or prevent the 
illness. But it also means that between each wave of small- 
pox, there is a lull, and that lull is the window in which 
vaccination could be carried out to eliminate the disease. 
If we could identify a case and immunize everyone around 
it, we could prevent the spread fairly quickly. 

Also, when the first symptoms of smallpox occur, people 
have high fevers and feel sick, so they take to their beds. This 
is important, because smallpox is essentially spread through 
close contact. In fact, one of the earUest examples of bioter- 
rorism may have taken place during the French and Indian 
War, when soldiers purportedly threw smallpox -infested 
blankets over the walls to unsuspecting Indians. 

I beUeve that the original recommendation of the Ad\'iso- 
ry Council on Immunization PoUcy, which was to immunize 
about 10,000 first responders around the country, was, in 
fact, a rational policy, not because I expect a smallpox 
attack, but because I believe that every medical institution 
needs someone who is comfortable examining people with 
smallpox symptoms. In California, for example, a woman 
recently appeared in a hospital with vesicular lesions on her 
hands. The doctors were understandably concerned about 
examining her. Yet when they took her history, they discov- 
ered that she milked cows and had contracted cowpox, a 
virus that resembles smallpox. 

Scientists ha\'e developed a number of scenarios to try to 
determine the risk of a smallpox epidemic in the United 
States. Given the way in which the virus is transmitted, I 
beheve that some of these scenarios are unrealistic, because 
they use "R" numbers — the number of cases that might arise 
from exposure to an infected person — that are too high, on 
the order of eight to ten. Sam Bozzette and his colleagues. 

who are part of our research group at the RAND Center 
for Domestic and International Health Security, recently 
pubhshed a paper in the New England Journal of Medicine in 
which he explored a number of scenarios for smallpox in this 
country. He looked at epidemics as they recurred through 
out history and found that the a\'erage R was about three. 
That is, if you do not intervene in the natural history of a 
particular case, about three additional cases will occur. 

It makes a big difference whether the number of cases in 
the cascade is three or ten. Bozzette showed that the only 
scenario that would justify x-accinating an entire popula- 
tion would be the aerosolized infection of large numbers of 
people at multiple sites, such as airports — a scenario with 
a relatively low probability compared to a series of single 
releases over time. As a result of those analyses, he con- 
cluded that it is not appropriate to vaccinate the general 
population on the basis of current information. The Insti 
tute of Medicine has also emphasized that if you're going to 
immunize small numbers of people, you need to study 
them carefully to understand what the effectiveness and 
side effects will be. 

All known stores of smallpox are located either in Russia 
or at the U.S. Centers for Disease Control and Prevention. 
The Russians have no more reason for letting smallpox out of 
their hands than we do. They do not want to be blackmailed 
by terrorists. The notion that Moscow might be a source is 
predicated on the theory that a disgruntled Russian scien- 
tist, out of work in a faltering economy, might sell the \irus 
to some rogue group or government. But think about how- 
valid our intelligence was on weapons of mass destruction in 
Iraq. Then ask yourself how good we might be at assessing 
this bioterrorist threat. 

How easily can smallpox be weaponized in large 
amounts? It's not easy to weaponize any of these germs. If 
the person who released anthrax had had access to a signifi- 
cant amount, I doubt he or she would ha\'e stopped at send- 
ing only two contaminated letters. We know smallpox 
weaponization is a risk, but the question is, where should 
we place it in the range of risks? 

Individual risk assessment is also key. It makes a differ- 
ence whether you li\'e in New York City, Chicago, San 



uestion is, where should we place it in the range of risks? 

Francisco, Los .Angeles, or East Cupcake. Because if you're in 
East Cupcake, it's unlikely that you'll be exposed to small 
pox, gi\-en the rclati\'ely small risk of an event and the k^w 
probability that it will occur in East Cupcake. 

Smallpox was originally controlled by ring vaccination, 
which in\-olves isolating confirmed and suspected smallpox 
cases and tracing, vaccinating, and using surveillance of 
their contacts. But a number of models have suggested that 
this approach won't work. At the very least, if we're going to 
use ring \'accination, we need to have a good national policy, 
stores of the vaccine strategically located around the coun- 
try, and first responders trained to mobilize rapidly. 

At the same time, should there be one proven case of 
smallpox anywhere in the world, it would be difficult not 
to offer the vaccine to everyone. If that one case is in the 
United States, people will argue that everyone who wants 
to be vaccinated should be given access to the vaccine. An 
interesting ethical question arises: if we have 380 million 
doses, and the first case appears in Britain, and public offi 
cials there don't have any doses, what do we do? 

After September 11, the secretary of the Department of 
Health and Human Services decided to obtain enough small- 
pox \'accines for everyone in the United States. He had a 
great deal of money, but he recei\'ed much less for his money 
than he had anticipated, because the pharmaceutical indus- 
try is not particularly interested in vaccine production. 
Vaccines cost an average of $800 mifhon to develop, and 
companies don't make much money from them, because 
recipients get only one or two doses. 

Since 1993, the Institute of Medicine has been advocat- 
ing for a national vaccine policy. I think the BioShield pro- 
posal that President Bush inaugurated this year, which is 
to provide five or six billion dollars of guaranteed market 
for new vaccines, is promising. But the industry skepti- 
cism about this proposal is enormous. The fear is that it 
will neither fully offset the cost of vaccine development 
nor offer a guaranteed return on investment. The return 
on investment of the defense industry is in the range of 7 
to 9 percent; the return on investment in the pharmaceu- 
tical industry is close to three times that. Convincing the 
pharmaceutical industry to pursue vaccines will be chal 

lenging. The biotech industry is more likely to be attract- 
ed to this opportunity. 

Public health in this country has been undersupported 
for at least 30 years, and we tend to respond only to 
individual threats. In 1964, I personally saw 100 cases of 
St. Louis encephalitis in New Jersey. This virus had been 
introduced at a time when mosquito abatement programs 
were discontinued and the bird population had become 
richly infested. We were able to control the spread of the 
virus by rapidly killing mosquitoes. 

But here we are in 2003, and the West Nile virus has 
descended on us because, again, our response to public 
health has been episodic. The anthrax attacks led to a 
$2.6 billion increase in funding this year, but we need 
sustained efforts in public health. And we must avoid the 
crowding-out effects — the tendency to work on bioter- 
rorism at the expense of chronic illnesses such as asthma 
in inner-city kids and a range of other pres.sing public 
health concerns. 

Smallpox illustrates the conflict between individual 
rights and community welfare. Many people have declared 
that they should be vaccinated if they want to be. But if the 
vaccine carries even a small risk of viral transmission to oth- 
ers, should they have the right to be vaccinated? This dilem- 
ma differs from those in the past, when the standard immu- 
nization argument was that individuals were vaccinated to 
protect the larger population. 

How do we strike the right balance? Life will never be as 
it was bctore September 11 and the anthrax attacks. But can 
we balance the risks and benefits in a way that will protect 
health without ruining public health systems? Can we do 
it in a marmer that will improve health without exposing 
people to undue risks? 

The bugs will continue to play plenty of tricks. Every epi- 
demic, every outbreak teaches us new lessons. We need to 
provide pohcymakers with the best data we can in the most 
honest and objective way we can. And we must insist that 
it's the data driving the decisions. ■ 

Kenneth Shine '61 is a senior policy fellow and director of the RAND 
Center for Domestic and International Health Security. 



by Joseph B. Martin 


challenges: the cultural chaos of academic 
health centers, content challenges in curricu- 
lum, the crisis in contemporary medical edu- 
cation costs, and culturally competent care. 
In focusing on the first of these, 1 am remind- 
ed of a quote attributed to President Dwight 
Eisenhower: "Things are more like they are 
today than they have ever been before." 

In his award-winning 1999 book. Time to Heal medical histori- 
an Kenneth Ludmerer of Washington University in St. Louis 
describes how the chmate for education in the United 
States was changing as we approached the twenty-first centu- 
ry. Under managed care, faculty clinical practices had expand- 
ed, but their profit margins had fallen, and as Ludmerer 
says, "Medical schools were running on an e\'er-quickening 
treadmill — seeing more and more patients to compensate tor 
continuing drops in profitabihty per case." The crisis in health 
care financing and the increased patient care responsibihties of 
chnical faculty meant that faculty members had less time for 
teaching, and less time and money for research — thus under 
mining the two central missions of their medical schools. 

These are the problems that Harvard Medical School and 
its extraordinary teaching hospitals face as we continue our 
adventure into the twenty first century. The past 18 months 

ha\'e been a time of intense self- 
evaluation of our teaching mis 
sion at Harvard Medical School. 
One driving force has been 
the accreditation process under- 
taken by the Liaison Commit 
tee for Medical Education, 
which began in the fall of 2001. 
The LCME site visit this 
April — which produced excel- 
lent re\'iews of our School on 
the whole — was preceded by 
long months of work by nine 
self-study committees, which 
scrutinized every aspect of the 
School's resources, operations, 
and outcomes. Most of these 
committees were concerned in some way, directly or indi 
rectly, with the educational experiences of our students. 

So what are we doing about this problem at Harvard Med- 
ical School? In the fall of 2001, Daniel Lowenstein '83, who 
was then dean for medical education, and George Thibault 
'69, director of the Academy at Harvard Medical School, 
established two ad hoc committees, which we called "blue 
sky" committees. These groups labored over the next year to 
produce a potential blueprint for major curricular reform at 
the School. The Clinical Blue Sky Task Force focused on the 
problems of clinical education and alternati\'es to the tradi- 
tional, discipline based clerkships. The General Blue Sky 
Task Force concentrated on the entire approach to medical 
education at Harvard, from undergraduate prerequisite 
courses all the way through graduation and the transition to 
residency training. Both task forces were encouraged to 

The task force was charged with making a set of critical' 

The dean of HMS seeks a blueprint for 
reforming the medical curriculum 

think broadly and stay outside 
the box as much as possible. The 
two groups met together in Sep- 
tember 2002 to synthesize their 

In January of this year, the 
Task Force for a New Curricu- 
lum was formed, co chaired by 
Phil Leder '60, chair of our 
Department of Genetics and a 
highly respected teacher, and 
George Thibault, a cardiologist 
with a lifetime commitment to 
student and resident education, 
to take the next steps. The task 
force was charged with making 
a set of critical decisions about 
the undergraduate medical edu- 
cation program and the (uture 
direction of the School. 

The group met intensively 
from January through early June. After reviewing the 
reports of the blue sky committees, the task force heard the 
perspectives of selected students and faculty on the current 
state of the curriculum and perceived areas for improve- 
ment. Task force members also reviewed recent reports 
issued by the Association of American Medical Colleges 
and the Shapiro Institute for Education and Research at 
Beth Israel Deaconess Medical Center, along with curricu- 
lar reforms at other U.S. medical schools. The task force 
issued a draft report, and I'd like to share with you some of 
its conclusions, with the caveat that the report is still a 
work in progress. 

MAPMAKER: Martin is leading 
the charge for currlculor reform. 

In its introduction, the ta,sk force noted that Abraham 
Flexner, in his historic 1910 report, had observed that "for 
medical education to flourish from one generation to the 
next, it [has]. reconfigure itself in response to changing 
scientific, social, and economic circumstances." The HMS 
task force added that "Medical education is in a constant 
relational process to scientific discovery and the delivery of 
medical carc.It is the responsibility of the medical profes- 
sion, and medical educators in particular, to be vigilant in 
configuring the medical school curriculum to keep pace v^ith 
the 'changing scientific, social, and economic circum 
stances,' " as Flexner urged nearly a century ago. 

decisions about the medical education program. 



linical education can only be reformed by 

The New Pathway curriculum, which began its planning 
stage 20 years ago, reformed and reimigorated the educa- 
tional experience for Harvard medical students and served 
as a national model for similar reforms. But despite all the 
New Pathway has accomphshed, one of its central aims — 
the true integration of chnical and basic science learning 
throughout four years of medical school — remains a largely 
unfuffilled promise. 

Given the vast changes in the practice of medicine over 
the past two decades and the explosive growth of scientific 
knowledge and technology, it is indeed timely that we now 
readdress the questions of the appropriate model for clinical 
education. There is a pervasive and growing sense — not 
only at Harvard, but around the country — that current 
approaches are no longer working. Let me report on some of 
the observations that ha\'e defined this sense of unease wdth 
the clinical of the student experience: 

• Hospital inpatient serxices are becoming less represen- 
tative of the full spectrum of illness and patient experi- 
ence. Rapid patient turnover limits opportunities for 
students to develop relationships with patients and 
follow their progress over time. 

• The increased pace and intensity of the hospital envi- 
ronment makes it less hospitable to the educational 
needs of students, who are often marginalized as mem- 
bers of inpatient teams. For example, students rarely 
take a history or perform a physical exam on inpatients. 

• Clinical faculty — particularly senior faculty — are less 
involved in students' education, and a student's contact 
with a faculty member or resident may be transient. 

• Ambulatory care offices operate with severe time con- 
straints, compromising the ability of students to learn 
well in those settings. 

• Evaluation of student performance is highly variable. 
The lack of direct observation of students by faculty 
is a major problem in both inpatient and outpatient 
settings. The tools used to assess students are not very 
useful in discerning whether they have achieved core 

• Students receive too little opportunity to appreciate the 
importance of science as the underpinning of cUnical 

medicine, and to address social, ethical, cultural, and 
professional issues. And finally, 
• The variabihty in the content and educational rigor of 
the clinical experience is unacceptable. Students are 
often not provided with exphcit clinical goals. 

In seeking solutions to these urgent problems, the task 
force went on to note that "close cooperation among the 
Medical School, affiliated hospitals, and clinical depart- 
ments wiU be required to design experiences that meet the 
educational needs of students and that can be implemented 
in the context of the present health care system." 

The deficiencies in the chnical setting are perhaps the most 
acute and glaring problems facing us. But chnical education 
can only be reformed by looking at the entire spectrum of the 
student experience. The task force pointed to se\'eral other 
issues invohing the medical education system as a whole. 

First, a major overarching concern is that basic science and 
clinical medicine are not well integrated across the four-year 
curriculum. Students lack clinical experience in the early 
years, and basic science is largely ignored in the latter years. 

STRENGTH IN NUMBERS: The rich contributions of the HMS 
alumni community have helped drive the dean's proposed 
curricular changes. 



looking at the entire spectrum of the student experience. 

Second, in the tutorial system — designed to be the cen- 
terpiece of the curriculum — both faculty and students 
have commented that the bar has not been set high enough 
for our students. The task force notes that, "The tutorial 
should be a constantly evolving process that changes with 
each course and continuously challenges the students" — a 
goal that has not consistently been met. 

Third, the task force compiled a Hst of questions that 
reveal the enormous scope and breadth of what we are 
embarking on as we look to reform our curriculum. Many 
of these questions go right to the fundamental nature and 
structure of medical education; What is the appropriate 
timing and sequence of the clinical and basic science expe- 
riences? What is the optimal duration of undergraduate 
medical education? What should the core requirements be 
for all students? 

Should students be encouraged or required to pursue a 
special interest or concentration? How should the final 
year of undergraduate education optimally be used, and 
how can the transition to postgraduate education be man- 
aged better? Are there important synergies that can be 
developed in the School's major commitments to prepare 
future physicians and scientists? 

How can we create the environment and opportunities 
for students and faculty to form meaningful and lasting 
relationships? Mentoring, yes; but perhaps as important, 
mere friendship. And, finally, how can we find better ways 
to reward clinical teaching? 

The challenges looming ahead are formidable, but the 
good news is that we are facing them from a position of 
great strength. Observers from within and outside the 
School have found much to praise. The LCME site visit 
team gave high marks to our educational and research 
programs; the excellence of the students, faculty, and 
leaders of the School and its teaching hospitals; the 
promise of the Academy to promote innovations in edu- 
cation; and our state of-the-art facilities and information 
technology infrastructure. 

We know it will not be easy to fix the problems facing 
us. The changes that have caused them are not going away. 
Like many other schools, we are looking for answers. But 
as it has throughout its history. Harvard Medical School 

again has an opportunity to take the lead in the search for 
these answers. Let me predict some of the recommenda- 
tions that the task force may choose to make: 

• A major restructurmg of the entire four year curricu 
lum — from start to finish. 

• Better mechanisms for supporting and rewarding teach- 
ing faculty. The new Academy at HMS is a step in that 
direction. Financial rewards, promotion, and recogni- 
tion for teaching wiU need to be addressed. 

• A review and, if necessary, a revision of the pedagogi- 
cal methods used throughout the curriculum, with a 
special emphasis on renewing and improving case- 
based tutorial teaching. 

• Identification of the most appropriate ways for students 
to achieve in depth educational experiences to comple- 
ment the breadth of the general curriculum. 

• A review and, if appropriate, a revision of the require- 
ments for admission to ensure that students enter med- 
ical school with the knov\iedge base and skills required 
for a modern medical education. 

• The establishment of a structure for curricular reform 
that includes an oversight or steering committee and 
interdisciplinary and inter- institutional working 
groups of faculty that focus on each of these recom- 

• The estabhshment of a built-in mechanism — using the 
Council on Educational PoUcy, the Academy, the acade- 
mic societies, the Office of Educational Development, 
and the faculty at large — for encouraging continual 
innovation, renewal, and evaluation of the curriculum. 

In the final pages of his book on medical education, Ken- 
neth Ludmerer calls for leadership and challenges us to 
address the issues he raises. We at Harvard Medical School 
accept that challenge. 

I look for\\'ard to working with our new dean for medical 
education, Malcolm Cox 70, over the next year to imple- 
ment the recommendations of the task force, and I will 
keep you posted regularly on our progress. ■ 

Joseph B. Martin, MD, PhD, is the dean of Harvard Medical School. 



Reunion Reports 

HMS alumni return for a time of celebration and remembrance j 



60th— 1943A Donald McLean 

The 60th reunion of the Class of '4 3 A 
(officially the last) began in the Quad- 
rangle on June 6 with picture-perfect 
weather. Following the festivities and 
lunch the class picture was taken. In the 
evening, the classes of 194 3A and 1943B 
gathered together in Gordon Hall (the 
old Building A) for a happy hour and a 
super dinner. Under the able direction 
of Ben Eiseman, members of both class- 
es were invited to relate episodes in 
their lives that had left lasting impres- 
sions on them. All of the tales were unre- 
hearsed and unforgettable. 

John Trakas and Morgan Berthrong, 
for example, described their experiences 
during the Battle of the Bulge in Bas- 
togne, where they were combat medical 
officers in different units. Their stories 
were indeed spellbinding. 

The final day, Bobby and Joe Murray 
'43B again brought closure to a memo- 

rable reunion with a part)- at their lo\-ely 
home. It may ha\'e been raining, but our 
fare\\'eU part)' was dehghtful and a won- 
derful way to remember our final reunion. 

Despite the festive atmosphere, \\-e 
were all deeply saddened by the loss of 
Arthur Guyton and his wife, Ruth, who 
died in an automobile accident in April. 

I wish to express our deepest appreci- 
ation to Jean Hurd of the Alumni Office, 
who ga\'e so much time and showed such 
dedication to making our reunion a suc- 
cess. I would also hke to thank all our 
devoted classmates who ha\'e worked so 
hard to make all ten of our reunions so 
successful and special. 

There is no more fitting way to close 
this report than to quote our late, beloved 
editor, E. P. Richardson, Jr.: "For those of 
us who are still around, let us keep up 
contacts with one another, through meet- 
ings or other opportunities that may 
come up. We are a lucky group." ■ 






60th— 1943B Joseph E. Murray 

As class agent, I receive many notes from 
classmates; especially treasured arc those 
from the widows and children of alumni. 
At our 60th reunion, John Hubbell and I 
shared some of them at the Friday class 
dinner in the faculty room and at the Sat 
urday brunch at my home. 

Especially memorable were photos 
that had been forwarded by the late 
Farrington Daniels, taken in the summer 
of 1943, when we shipped off to Fort 
De\'ens for our acti\'ation to military duty. 
Dick Bagnall recalled that during the war 
he had been sent to Yale to learn about 
health problems in the Far East and to 
study com'ersational Japanese. He ended 
up first in Okinawa and then in Korea. 
Dick's troops took care of the surrender 
of the Japanese at the end of the war. 

On a more contemporary note, we 
were pleased to learn that Bob Glaser had 
been honored at Harvard's commence- 
ment exercises. Bob received the Harvard 
Medal in recognition of his extraordinary 
service to the university. 

Bill Garrido-Lecca's health did not 
allow him to tra\'el, but he sent his best 

wishes to all of his classmates and a beau- 
tiful bouc(uet as well. 

John TuthiU's family has established a 
land trust on Martha's Vineyard, which 
is a joy to all of us who drive by it in our 
travels there. 

BLU Pollock's widow, Margaret, men 
tioned that she and Bill had tra\'eled all 
o\'er the world, including both poles, and 
had enjoyed a full life together. She 
remembered fondly our prc\ious reunion. 

John Lloyd, who died last fall, deserves 
special comment, for as a surgical resident 
with me at the Brigham, his kindness in 
the care of each patient was outstanding. 

John Winslow's widow, Ellie, was 
sorry that she had never come to know 
many of John's HMS friends but she knew 
of his great lo\'e and respect for the 
School and his experiences there. 

Maxine Clarke came with her daughters 
Mary and Nancy. Their presence added 
to the warmth of the occasion, as did that 
of Rudy Jaworski's daughter Judith. 

Since the reunion, I've received many 
warm letters of thanks. It is a privilege to 
be able to share my experiences at HMS, 
a veritable fountain of youth. ■ 





55th— 1948 Alfred Scott 

Twenty classmates returned for our 55th 
reunion. Considering that there are 90 sur 
vi\ing of our original 141, this is not as high 
a percentage as we might ha\'e hked, even 
taking our increasing ages and disabOities 
into account. Nonetheless, those who did 
attend, mosdy with spouses, found the 
renewal of friendships greatly enjoyable. 

We were fortunate to have our two 
deans, Dan Tosteson and Howie Hiatt, 
in attendance. Dave Chamovitz won the 
distinction of having traveled the far- 
thest (from Israel). We also had three 
classmates from California (Jerry Apple- 
garth, BiU Kiyasu, and Tom Vecchio), and 
from Arizona the irrepressible Roger 
Wilcox. Sig Gundersen has made all of 
our reunions. Walter Rattan also attend- 
ed from Wisconsin. Al Simkus came 
from Florida, Gene Brand from Virginia, 
and the rest of us from New England. 

Thursday, many attended either the 
25th class symposium or the faculty sym- 
posium on technology in medical educa- 
tion and practice. Both were excellent. 
After the symposia, we convened for a 
reception in the third floor atrium of 
Gordon Hall. It is hard to believe that 
such a pleasant room exists in the old 
Building A. The School certainly changes. 

Friday s acti\ities included .Alumni Day 
on the Quadrangle, which featured an 
alumni symposium on smaUpox and Dean 
Joseph Martin's outlook on the upcoming 
changes in the curriculum. That ex-ening 
we gathered 38 floors above Boston in the 
Bay Tower Room for cocktails and dinner. 
The usually fickle weather cooperated 
and the views over Boston Harbor at 
sunset were spectacular. 

On Saturday, 16 of us opted to move 
to the Colony Hotel in Kennebunkport, 
Maine, for the weekend. Our "weekend 
out of Boston" reunions have all been 
memorable and this one was no exception, 
taking place at a \'ery pleasant resort hotel. 

These actixities really proxide only a 
background to the more important and 
most enjoyable feature of these reunions; 
the opportunity to com'erse one on one 
with classmates with whom we once 
shared a common experience and to dis- 
cover how our lix'cs and thoughts ha\'e 
changed since we last saw each other. 

Our special thanks to Jim Bougas and 
Cris CriscitieUo for their work on the 
reunion report and to Ed Gray for keeping 
all our expenses in order. Jean Hurd and 
the Alumni Office staff handled most of the 
organizational details; that they can do this 
for all the returning classes is remai-kable! ■ 




50th— 1953 lolanda E. Low 

The 50th reunion, the "Big One" for our 
class, started with a welcoming get 
together in the Countway Library with 
hors d'oeuvres, lively conversation, and 
varying reactions to name tags with our 
'49 pictures, which erased the past 50 
years as if by magic. The evening became 
truly elegant with the wonderful music 
provided by Phil Bromberg (violin), 
Fritz Loewenstein (viola), and Lucy 
Riesnian Loewenstein (cello). They 
played the music of Beethoven and 
Schubert, as well as the Romanza move 
ment of Dohanyi's Serenade op. 10, in 
memory of cellist Peter Keleman '52. 

Alumni Day was chaired by our o\\ n 
Dan Federman. For us, the highlight 
came when Marilyn Karmason Spritz 
presented the 50th reunion gift of 
approximately $260,000, one of the 
largest raised, to establish "The Class of 
1953 Scholarship" in perpetuity. 

That e\'ening we reassembled at the 
Downtown Har\'ard Club. Before we sat 
dowm to a lovely meal, a solemn moment 
was invoked by reading the names of our 
departed classmates and observing a 
moment of silence in their memory. Class 
mates then shared memories both funny 

and sad of our years together, family and 
professional milestones, and plans and 
hopes for the future. It was an informal 
but emotionally satisfying way of creating 
a bond among so many who had traveled 
long and diverse paths since graduation. 

Though Saturday started out clear and 
dry for our marine excursion on Boston 
Harbor, the rain came earlier than antici- 
pated. But nothing fazed our group; the 
excellent lobster feast, nonstop conver- 
sation, and general camaraderie did not 
allow the weather to dim our enjoyment. 

The unofficial tally in attendance was 
52 classmates plus 45 spouses. We were 
especially glad that Charles Bauer was 
able to join us, despite physical hmita- 
tions. We missed the approximately 60 
who were not with us, some because of 
poor health, and we wish them the best. 

We parted feeling that we will do 
everything to get together again for our 
55th, perhaps extending the reunion to 
include, once again, a weekend. 

Last but not least, my thanks to the 
'53 reunion committee — which included 
James Peters, treasurer; Dan Federman, 
editor; Edwin Carter; and Joseph Ciano — 
and the Alumni Office staff, especially 
Patrick Rivera, for their invaluable help. ■ 





45rti— 1958 Anthony Patton 

The 45th reunion of the Class of 1958 
started and ended in a joyous and con 
vi\ial fashion. But despite the overall 
theme of fun and food, some serious 
issues — such as the future of medical 
education at Harvard — cropped up. 

On Thursday e\'ening, 84 people met 
for cocktails and dinner under the steely 
eyes of our great founders in the Faculty 
Room of Gordon Hall. Our speaker was 
Gordon Harper "69, who has been instru- 
mental in the de\'elopment of the HMS 
Patient/Doctor program. Dr. Harper 
explained the value of allowing students 
to discuss the emotional and practical 
issues of dying, patient anger, staff con- 
troversies, and other prickly clinical and 
ethical situations. His speech sparked 
discussion during the whole weekend. 

The Class of 1958 retired to the Stage 
Neck Inn on the ocean in York, Maine. On 
Friday evening some 52 classmates and 
their spouses enjoyed a typical Maine 
clambake. On Saturday morning, most of 
us participated in a free-ranging group 
discussion led by Jeannette and Howard 
Corwin (both articulate psychiatrists 
and our class agents). The focus was on 

attitudes and choices we make about life, 
careers, and even death. After a spirited 
round of comments, Howard, with a par- 
tial attribution to Freud, summed up his 
view that happiness in life is made up of 
love, work, creativity, and the capacity to 
be at peace with yourself. (Your class 
reunion chairman would add a sense of 
humor and an abiUty to change.) 

Despite an afternoon downpour, some 
ventured out to take historical tours and 
to see the Maine coast. On Saturday night, 
Elhott Miller spoke about the controversy 
surrounding Wilham Morton's demon- 
stration of ether as an effective and safe 
anesthetic agent in 1846. It was a stimu- 
lating evening and more reminiscing went 
on into the wee hours. 

Sunday breakfast ended the proceed- 
ings and we all returned to our private 
hves, invigorated by renewed contact 
with our classmates. I thank the commit- 
tee, particularly "Bernie" Carpenter, our 
treasurer, for all his help. Special thanks 
to Pete Coggins and George Jacoby for 
their work on the class book, and acco- 
lades to Jean Hurd in the Alumni Office 
for doing such a fine job in pulling it all 
together. Here's to a merry 50th. ■ 

Tve i> V 


40th— 1963 Paul J. Davis 

Members of the Class of 1963 met this 
year in Boston to commemorate the 40 
years since medical school graduation. 
Forty-seven classmates and 33 signifi 
cant others convened Thursday at the 
Vineyards' home in Brookline for a buf- 
fet dinner, at which the Lewits offered 
uncorrupted, newly minted CDs of the 
Second Year Show staged by the class 42 
years ago. The show wears well and is 
ranked by Elvis Mitchell among the ten 
best Second Year Shows ever produced 
on Avenue Louis Pasteur or elsewhere. 
Selected members of the Dental School's 
40th year class also attended the Vine- 
yard party, a wonderful evening of rem 
iniscences and updates. We're very 
grateful to Gordon and Phyllis. 

On Friday evening, class members met 
for dinner at The Country Club. TCC has 
changed little since Francis Ouimet won 
the U.S. Open golf championship and 
certainly has not changed at ail since we 
were interns. Politics replaced reminis 
cences as the principal topic of dinner 
discussion. On Saturday, a smaller group 
of classmates cruised the Charles. 

For those of us who keep track, 19 
states were represented at the reunion 
and we drew well from the faraway 
places, such as Florida, California, Geor- 
gia, and Oregon. One classmate had to 
choose between the reunion and Bulgaria. 

The 40th reunion gift to Dean Joseph 
Martin for the Scholarship Fund was 
$148,500. This is about five times our 
annual giving and was the goal we set 
out to achieve in a fundraising effort 
that involved many classmate-solicitors. 

The Class of 1963 is very much in 
debt to the remarkable Alumni Associa- 
tion staff — particularly Jean Hurd — 
and to the local Planning Committee for 
the lovely evenings. Committee mem- 
bers were Gordon Vineyard (chair), 
Harley Haynes, Katie Wolf, Gordon 
Moore, Irene Briggin, Dick Monson, 
Andy Warshaw, Marshall Wolf, Tom 
Halpin, and Bob Fvans. 

E. A. Robinson's old Eben Flood said 
that "many a change has come to [all] of 
us, I fear, since last it was we had a drop 
together," but, aside from increasing 
radiance, members of the class have 
changed little. ■ 





35th— 1968 David D. Oakes 

The 35th reunion events proceeded on 
time and as scheduled. The clockwork 
efficiency will come as no surprise to 
those who know Jean Hurd and her 
associates in the Alumni Office — many 
thanks for their invaluable help. 

Thursday evening was a cocktail 
party in the Minot Room at the Count 
way. Except for a lamentable absence 
of California wines, the event was an 
unqualified success. Conversation was 
nonstop as 23 classmates and guests 
reminisced and "reuned." 

Friday evening we recomened for a 
reception and dinner at the Har\-ard Club 
on Commonwealth Avenue. Com'ersa- 
tion flowed unabated. The Reunion 
Committee failed to pro\'ide for formal 
after-dinner speeches; no one com- 
plained. Eighteen of 36 attendees ordered 
beef. Are we ignorant, stubborn, or both? 

Saturday afternoon Susan and Steve 
Pauker once again graciously hosted a 

lobster- clam bake at their lovely Weston 
home. A rainstorm forced 52 of us to 
cower cheek- by jowl inside a pro\iden 
tially pro\ided tent. This only added to 
our sense of closeness and camaraderie. 

Name tags were provided for all 
events, but for the most part were unnec- 
essary; except for Laird, most of us have 
not changed that much. 

I was sorry that Michael LaCombe did 
not attend. We are all grateful to him for 
faithfully chronicling our personal and 
professional Uves. These periodic snap- 
shots remind us of who we were, who we 
are, and who we hope to be. 

In all 35 classmates (out of 141) attend 
ed at least one reunion event, as did 24 
guests. Of these, approximately 70 per- 
cent had attended the 30th reunion in 
1998; we must be doing something right! 

Since 1998 we have lost three class- 
mates — Robert A. Frederick, Alan B. 
Munro, and John P. Hejinian. We note 
and mourn their passing. ■ 





30th— 1973 Barry Zitin 

Friends and classmates from near and far 
gathered for a fabulous 30th reunion that 
attracted around 40 members of the Class 
of 1973 — a very good turnout, better than 
"good" but less than "superb." Friday's 
■•\lumni Day fcsti\'ities featured gorgeous 
weather, a symposium led by Dan 
Federman '53 (is he ever going to age?), 
a delicious lunch, and lots of laughs. 

Some of us wandered into the Quad 
rangle buildings or took a tour of Count 
way Library. A few of us "stormed" into 
Vanderbilt Hall, past the recent grads 
mo\'ing out. We found our old rooms, 
took pictures around the tennis court, 
and marveled at the dorm upgrades 
(kitchens! elevators!) while mourning 
the loss of the beloved cafeteria space. 

Our class gathered for dinner at the 
Museum of Science, but the beautiful 
views could not measure up to the joy of 
seeing old friends again. On Saturday, we 
paid the price for Friday's perfect weath 
er: our lobster feast at Mike Rosenblatt's 
home was spent huddled together under 
tents to avoid the drenching downpours. 
Whatever the weather, everyone was 

having so much fun (maybe the huddling 
was a good thing) that our spirits were 
barely dampened. The rain never let up: 
by the time we had to say goodbye, there 
was a lake in the Rosenblatt backyard! 

Thanks to the Reunion Committee 
for all their arrangements and thanks to 
all who joined us. We expect a bigger 
turnout in 2008 and absolutely guarantee 
better weather for Saturday's event. Oh 
yes, and we'll all look as young as ever... ■ 

Richard Peinert 

The Class of 1973 returned for our 30th 
reunion with a respectable showing of 
about 40 classmates attending some or 
all events. I managed to miss the class 
photo but received one from our class 
oral historian, Linda Covell Davis. Too 
bad 1 missed the picture, because every- 
body is starting to look old except me! 

We enjoyed a wonderful Friday night 
dinner at the Museum of Science that 
offered spectacular views of Boston and 
the Charles River. George TuUy gave a 
one minute speech, leaving plenty of 
time for all to get reacquainted. Mike and 
Patty Rosenblatt once again hosted our 
traditional feast at their lovely home on 
Crystal Lake. Talk of career and achieve- 
ment has pretty much given way to rem- 
iniscences of the "old days," family talk, 
and a cataloguing of various ailments 
and joint replacements. We have a few 
career changes. Steve Bergman is now a 
venture capitahst andjim Reinertsen is a 
fuU-time consultant. We also had a first- 
time reunion returnee in Morgan Jack- 
son, who wins the award for best pre- 
served member of the class. 

A special treat was a DVD of the infa- 
mous Class of '73 Ether Dome reenact- 
ment, along with some footage of Camp 
HMS during our first summer. 1 believe 
this was a joint effort of the Rosenblatts 
and Weinbergers. From 8 milhmeter to 
DVD! Ain't technology grand! Speaking 
of technology, the digital cameras were 
c\'erywhere and every permutation and 
combination of class members was cap- 
tured by any number of digital Eisen- 
staedts. Best of all, everybody truly 
enjoyed each other's company. I'm look- 
ing forward to number 35! ■ 



rv ■k^ \j %i 

- i"" 



25th— 1978 Roberta Isberg 

As we entered Building A on Thursday 
morning, our enthusiasm for reconnect- 
ing had akeady been inspired by the 
refreshingly honest submissions to our 
25th reunion report. We came to this 
reunion with a wealth of knowledge 
about our classmates and were able to 
deepen that understanding over the 
course of the three days. 

Our class symposium \\'as thoughtful- 
ly organized by Susan Okie and Nancy 
Rigotti to highlight the personal odysseys 
and professional achievements of our 
class. Bill Frist opened our morning ses- 
sion on "Fixing the Health Care System." 
He described how his medical back- 
ground informs his work as U.S. Senate 
majority leader. Allan Detsky led us 
through a chronology of the SARS out- 
break in Toronto, where he is physician- 
in-chief at Mount Sinai Hospital. His pre- 
sentation described the discovery and 
containment of the outbreak, as well as 
the intense emotional experience of 
treating an epidemic among health care 
workers. Allan brought his unique capac- 
ity for wit, incisiveness, and contro\'ersy 
to this moxing session. In our discussion 

of "Plagues and Pubhc Health Chal- 
lenges," Charhe \ an der Horst took us on 
a whirlwind tour of his AIDS projects in 
South .-Vfrica as well as his attention-get- 
ting methods of teaching sex education in 
North Carolina high schools. Kathleen 
Toomey described the challenges she 
faces as director of pubhc health in Geor- 
gia. Responding to such diverse pubHc 
threats as bioterrorism and the Walker 
County crematorium's illegal disposal 
of corpses, she has had to win the confi- 
dence of FBI agents and poMce officers. 

The afternoon session began with the 
"New Pathways" that our classmates have 
taken outside of medicine. Rob Huizenga 
showed a \ideo from our Fourth Year 
Show as well as from a Hollywood movie 
inspired by his experience as internist 
for the Oakland Raiders. Joe Brewster 
showed a chp from his independent film. 
The Keeper, and highlighted the common 
goals of his cinematic and psychiatric 
work; reflecting truth and addressing 
conflict, particularly racism. We ended 
with a session on sur\'i\'al skills that 
addressed challenges we all face: "How 
Intimate Relationships Sur\i\-e," by Bob 
Waldinger; "Balancing Personal and 
Professional Life," by Ouri 
Malliris; "Caring for Aging 
Parents," by Muriel Gillick; 
and "Personal Coping Skills 
to Survive a Malpractice 
Suit," by Lew Rose. Dinner 
in the Medical Education 
Center was attended by 84 
of our 162 classmates, plus 
spouses and kids. 

On Friday evening, 
Phyllis Carr and George 
Whitelaw graciously host- 
ed a lovely dinner at their 
home. Far from the critical 
eyes of our teenage chil- 
dren, we were free to dance 
to our hearts' content and 
our musculoskeletal limits. 
On Saturday Roger and 
Marie Pasinski hosted a 
family picnic at their 
Nahant home, located on a 
beautiful rocky point that 
we toured in the rain. We 
brought home renewed 
moti\'ation to stay in touch 
and to reunite in 2008. ■ 



!%t; j[i»< 



20th— 1983 Edward B. Bromfield 

The 20th reunion of the Class of 1983 
began with the Alumni Day symposium 
and class picture, which included an 
enthusiastic group despite the absence 
of several late arrivals. Later on Friday 
afternoon, a small contingent, led by 
Randy Hickle, answered a challenge by 
the Class of 1978 to a basketball game at 
X'anderbilt Hall. Our more junior but no 
more youthful team had a commanding 
lead before the game was terminated by 
the inevitable injury. 

On Friday evening, nearly 50 of us met 
at the beautiful Wenham home of Hank 
and Audrey Frissora for a dinner dance, 
the dinner pro\'ided by Stone Soup and 
the dance by Barrence Whitfield and the 
Savages. After enjoying the gourmet 
food, most of us stayed until the band 
had to pack up, proving that our class 

can rock as long, if not quite as smoothly, 
as we did 20 years ago. 

On Saturday afternoon, we made our 
way, along with several who had not been 
able to attend the night before, to Little 
Compton, Rhode Island, where we 
enjoyed a picnic with our families while 
looking out over Sakonnet Bay from Sher- 
ry Haydock's lovely summer house. The 
unsetded weather did nothing to diminish 
our enjoyment at reminiscing and catch 
ing up, as well as packing in the barbecue 
pro\ided by Redbones. The younger and 
more adventurous were even able to get in 
a voUeybiiU game and a walk to the beach. 

Thanks to the efforts of many, particu- 
larly Ann Taylor, Hank, and Sherry, and 
to Jean Hurd and the Alumni Office staff, 
our 20th provided not only many new 
memories, but also a firm foundation on 
which to begin planning our 25th. ■ 





15th— 1988 Edward Ryan 

The Class of 1988 had a wondcrhil 15th 
reunion. Two days of events were kicked 
off with Alumni Day on the Quadrangle 
including our class photo. On Friday 
evening, June 6, the class met for cock 
tails at the Commonwealth Brewery in 
downtown Boston. Approximately 30 
classmates were able to join this event. 
On Saturday, June 7, the class held a 
reunion picnic at Rocky Woods Reser\'a 
tion in Medfield, Massachusetts. About 
35 members of the class attended, with 
most bringing spouses and kids. 

The stormy day was sa\'ed by our 
large, covered picnic area. Ignoring the 
shelter, the children had a wonderful 
time playing in the rain, and we all 
enjoyed the barbecued chicken, spare 
ribs, and assorted salads. 

Everyone agreed that Jeff Ecker and 
Nick Blevins did a wonderful job 
putting together the 15-year report on 
the class. Many thanks should also go 
to Alan Hartford for organizing all the 
finances for the reunion events. (Alan 
enjoyed that trip to Bermuda...) Look- 
ing forward to the 20th. ■ 





10th— 1993 Mahalakshmi 

The tenth year reunion for the 
Class of 1993 was a wonderful 
gathering attended by approx 
imately 40 class members. The 
dinner at Davio's in Cambridge 
showcased the beauty of the 
Boston skyline and facilitated 
much reminiscing about our 
time together at HMS. The 
dinner itself was dehcious, and 
we had to curtail lively conver- 
sation so that the wait staff 
could serve the meal. 

The weather was not as 
cooperative the following day 
at the picnic on the Charles 
River. Rain waterlogged the attendees 
as well as the watermelon. Ne\-ertheless, 
it was delightful to see so many chil 
dren, who lo\cd splashing in the mud. 
The reunion activities ser\'ed their pri 

mary purpose, which was to reconnect 
and re-establish friendships that began 
with a common experience at HMS. 
Many of us look forward to our 15th 
reunion activities! ■ 

5th— 1998 Larry Rand 

In true Class of 1998 fashion, we set a 
record, having the largest number of 
attendees ever present for a fifth reunion. 
Forty-five of us joined together at the 
four-star Radius restaurant in dowTitown 
Boston, where we caught up while 
enjoying kumquat mojitos and hme rick- 
eys. We devoured a stellar meal in our 

own pri\'ate dining room, the place abuzz 
with giddy folks dressed in their finest, 
the tables overflowing with laughter, sto- 
ries, and renewed friendships. 

We were graced by the presence of 
family members of our beloved late class- 
mate NeU Ghiso, and members of Neil's 
HST class shared an emotional tribute 
filled with anecdotes. Before dessert, we 
went around the room to update each 
other on our h\es. Listening to our class- 
mates tell us about their childbirth stories 
( Jessica deUvered Arm's baby, then Ann 
went on to become Jessica's baby's pedia- 
trician), their business plans, and their 
international health involvement and 
altruism truly was the icing on the cake. 

The following afternoon we gathered 
on the beach in Marblehead for a tradi- 
tional New England clambake. Despite 
rain, there was laughter, clam chowder, 
husbands and wives, steamers, music, 
lobster, and pictures — lots of pictures. 
Our group picture at the clambake was a 
triumph; rows of accomplished and bril- 
liant people, people who change the 
world every day — just simple folks, with 
the ones they love at their side, sharing 
that space with lifelong friends. Oh, what 
friends we have. ■ 







Life in the Slow Lane 


late in psychiatrists' brains as 
they seek to unravel the com 
plexities of the human mind. 
But at least one psychiatrist has de\'Oted 
his life to pursuing the empty mind. And 
now that he's retired from medicine, 
James H. Gordon '66 is putting to use his 
training as a lay monk in the Zen tradi- 
tion by running a Buddhist retreat house 
in upstate New York. 

Gordon became dexoted to Buddhism 
in 1969 when he stumbled across a copy 
of a well-known work on Buddhist phi- 
losophy. The Three Pillars of Zen. "I knew 
immediately, after reading the book, that 
this was for me," he says. By the time the 
U.S. Army tapped him for ser\ice in 1971, 
Gordon had joined a Zen meditation 
hall — known in Japanese as a "zendo" — 
and was deeply committed to a philoso- 
phy that seemed incompatible with par- 
ticipating in armed conflict. He refused 
to enter the military on the grounds of 
being a conscientious objector. 

Gordon was subjected to three sepa- 
rate interviews, with a clergyperson, a 
psychiatrist, and an Army representa- 
tive. "The minister and the psychiatrist 
pronounced me sane and sincere," he 
recalls, "but the military guy claimed I 
was making it all up to avoid service." 
In the end, the Army refused to grant 
Gordon's request and he was arrested 
and threatened with a court-martial. 
Gordon fUed a civil suit, and when it 
became clear to military authorities 
that were going to lose the case, they 
offered him his freedom in exchange for 
dropping the suit. 

Other changes were on Gordon's pro 
fessional horizon. While working as an 
internist in a neighborhood clinic in 
Brooklyn, Gordon took a psychiatry 
course for general practitioners and dis- 
covered a new vocation. After a three- 
year residency, he became a psychiatrist 
working in hospital settings with seri- 

ously, often terminally, ill patients. 
Throughout this period, he continued his 
regular practice at the zendo, attended 
weeklong Zen retreats, and immersed 
himself in the related arts of the Japanese 
tea ceremony and calligraphy. 

The zendo he attended for several 
years, Gordon says, was one of the best 
places then available for Westerners to 
study Zen Buddhism, which was only 
beginning to gain students in the Unit- 
ed States: "In many ways, that zendo 
was the meditation world's equivalent 
to HMS at the time. I've been very for- 
tunate to have had access to some of the 
best teachers both in medicine and 
meditation," he says. "Of course," he 
adds, "we were such beginners back 
then. To have our particular Japanese 
master guiding us was like having a col- 

lege professor teaching preschoolers. He 
trained the first generation of American 
Zen practitioners." 

In 1976, Gordon began studving with 
a new Zen teacher, who continues to 
instruct him xigorously to this day, even 
though the teacher is now 96 years old. 
The master rehes on an English transla- 
tor when giving talks. But in one-on- 
one sessions with students, the linguis- 
tic barriers do not present any impedi- 
ments, Gordon says. "I know this must 
sound impossible to people not familiar 
with Zen practice, but the really great 
teachers can assess your condition 
merely by looking at you. Besides, 
nobody can do the work of enlighten- 
ment for you; only you can do the work 
for yourself. The master is there primar- 
ily to serve as an example. The student 


I was working with very sick patients, many 
my own mortality. But my Zen practice gave 

BRAIN DRAIN: The meditation practice of 
zazen helps Gordon to unclutter his mind. 

obser\'es how the teacher is. The teacher 
makes suggestions to prevent the stu- 
dent from wasting time dowTi blind 
alleys. And when you know, well, you 
blow that you know. It's as plain as the 
nose on your face." 

The basic work underpinning the 
Buddhist philosophy he follows, Gordon 
says, is the meditation practice known as 
"zazen." This practice of emptying the 
mind and cultivating a state of nonjudg 
mental awareness is a daunting challenge 
given the mind's natural, relentless 
stream of acti\'ity. Beginners might start 
by trying to sit for just ten minutes, grad 
ually adding to the time as their skill level 
increases. While he was still practicing 
medicine, Gordon himself supplemented 
his daily, hour- long zazen practice with 
intensi\'e weeklong retreats twice a year. 
These physically grueling retreats — 



during which participants would engage 
in group practice sometimes from 
3:30 a.m. to 9:30 p.m. — would help his 
understanding break open. 

"It's only recently that technology has 
been used to study what goes on in the 
brains of meditating people," Gordon 
says. "What's more important is that 
Zen practice really informs how you 
live." It has certainly shaped the way he 
carried out his work as a psychiatrist. 
"I was working with \'ery sick patients, 
many of whom were dying," Gordon says. 
"Caring for them constantly reminded me 
of my own mortalit)'. But my Zen practice 
gave me a demeanor that helped me calm 
my patients." 

It was an attitude that Gordon tried to 
impart to his students as well. For the last 
ten years of his career, he worked mamly 

dF whom were dying. Caring for them constantly reminded me of 
ne a demeanor that helped me calm my patients." 

as an instructor, teaching medical interns 
interview skills and strategies for making 
the difficult transition from student to 
doctor. "Interns need to learn so many 
hard lessons, such as how to break bad 
news to patients, how to deal with angry 
people, how to deal with time pressures, 
and how to keep from getting burned 
out," he says. "I tried to teach them by 
example, just as my Zen master has acted 
as a model for my own continuing medi 
tation studies." 

It is doubly hard, Gordon beUeves, to 
work in medicine today, with managed 
care pressures and other stressors. 
"There's a lot of suffering among doctors," 
he says. "That old expression, 'Physician, 
heal thyself,' should really be connected 
to the notion of 'Physician, biow thyself." 
Cultivating a steady awareness can help 
doctors resist the tendency to get so 

caught up in the stresses of the profession 
that they lose sight of why they entered 
medicine in the first place. And because 
Buddhism is not a proselytizing school of 
thought — you experiment so you can 
know for yourself — on one level, it 
resembles the scientific method in which 
doctors are trained." 

When Gordon and his wife, a psy- 
chotherapist and fellow student of 
Buddhism, met 12 years ago, he began 
planning for his deepest wish: to open a 
meditation center. Maitreya House, 
which they now run together in a bucoUc 
Catskills setting in Roxbury, New York, 
is both a Zen center, offering a regular 
schedule of meditation practice, and a 
bed and breakfast. The idea was to create 
a place where people could rest, think, 
and refresh themselves. "I always knew," 
Gordon says, "that if I ever got good 

enough at Zen practice, I'd like to be able 
to provide such a retreat." 

After he left his psychiatry practice, 
Gordon says, he finally got the opportuni 
ty to contemplate the difference between 
knowledge and wisdom. He believes that 
students are taught a great deal of the for 
mer in medical school these days but not 
necessarily enough of the latter. 

Although his lifestyle is modest by 
material standards, Gordon feels 
blessed to be leading what he charac- 
terizes as a remarkably rich life. "I'm 
ignorant," he says, "and to go deeply 
into this work requires a long time. I 
like to think of myself as being in my 
34th year of residency — and I still have 
a long road to travel." ■ 

Beverly Ballaw is associate editor of the 
Harvard Medical Alumni Bulletin. 



'J5 ^ 'C 




< j^ '■ ■» 

-. £■ ■^' f 

o ? " "• 
a- <i tL 

/^ r- r, — 

I I > 

P ro c 

^ I 

C3 -3 C 
X - CO 






> o